A Study on Clinical Profile and Complications of Acute Pancreatitis at a Tertiary Care Centre, Ahmedabad: A Case-Series

Introduction: Acute pancreatitis accounts for 3% of all cases of abdominal pain among patients admitted to hospital in the UK. The prevalence of pancreatitis in India is 2.6-3.2 cases per 100,000. Major causes of acute pancreatitis are biliary calculi and alcohol abuse. Acute pancreatitis may be categorized as mild (interstitial oedematous pancreatitis), moderately severe acute pancreatitis or severe (necrotising pancreatitis). The majority of patients will have a mild attack of pancreatitis. Severe acute pancreatitis is seen in 5–10% of patients, and is characterized by pancreatic necrosis, a severe systemic inflammatory response and often multiorgan failure. Objective: To study Age, Sex distribution, Etiology, Clinical presentation & complications of Acute Pancreatitis. Methods: Retrospective Observational Study of 10 patients presenting to civil hospital, Ahmedabad OPD/Emergency department with complains of abdominal pain and showing acute pancreatitis on ultrasound or CT scan were included. Results: Out of 10 patients, 40% were from 50-59 year age group, 70% were males, 60% were Chronic Alcoholic, 50% had Pleural effusion, 80% had Ascites and 30% had Pancreatic necrosis. Conclusion: Acute Pancreatitis is common in adult males with Alcohol abuse and second common etiology being Gall stones. Common sequeae include Ascites and Pancreatic Necrosis

A Study of Chemical Composition of Gall Stones in a Tertiary Care Hospital.

Gallstones are a major health problem & have been recognized since antiquity. Gallstones are generally classified into pure cholesterol, pigment and mixed type. Knowing the chemical composition of gallstones is essential for determining etiopathogenesis of gallstone disease. Fourier Transform Infrared Spectroscopy (FTIR) method is the most widely used technique in chemical analysis of gall stones. Reports on chemical analysis of gallstones are available from different endemic regions of India. However, no reports are available about the composition and etiopathogenesis of gallstones in Himachal Pradesh. METHODSGallstones from 400 patients of cholelithiasis were collected after cholecystectomy at Indira Gandhi Medical College Hospital (I.G.M.C.), Shimla, between June 2016 to June 2018, and were subjected to chemical analysis by FTIR method. The data was further correlated with regard to age, gender, socio-economic status, various life style factors like diet, obesity, physical activity, with stone number and colour. RESULTSChemical analysis of gall stones revealed that pure cholesterol, mixed and pigment variety were 94 %, 2 % and 4 % respectively. Majority of the patients were below the age of 50 years (66 %). Male to female ratio was 2.7:1. Both sexes had predominantly pure cholesterol stones. Most of the patients belonged to the lower middle class (56.5 %) & all socio-economic classes showed predominantly pure cholesterol stones. Similarly, there was no predilection of any type of stone to a particular physical work category. 53.5 % patients were non-vegetarians and 46.5 % were vegetarians. There was no correlation between diet and BMI with type of stones. In our study, 66 % of patients had multiple stones. Multiple stones were seen in all varieties of stones. Pure cholesterol stones showed a variety of colours contrary to traditional classification. CONCLUSIONSIn Himalayan population, the predominant type of gall stones were pure cholesterol stones. Mixed stones and pigment containing stones were found in much smaller frequencies. This result is in contrast to that of rest of the Indian subcontinent from where larger percentage of pigment and mixed stones has been reported. And pure cholesterol stones showed maximum variation in colours contrary to our expectation.

Prevalence of Non-Alcoholic Fatty Liver with Gall Stones Disease in Himalayan Population

Non-Alcoholic Fatty Liver Disease (NAFLD) is the hepatic pandemic of the 21st century. It is the amassing of fats in the hepatic tissue without significant alcohol intake that results in hepatic steatosis. Patients with gall bladder stones may have associated NAFLD as these ailments share similar factors like obesity, hypertriglyceridemia and diabetes mellitus. However, few, if any, reports are available about the association of NAFLD with gallstones in the hilly population. Hence, this study was conducted to find out the prevalence of NAFLD in patients with gall bladder stone disease.METHODSThis study was done in the Department of Surgery, Indira Gandhi Medical College, Shimla, from June 2017 to May 2019. A total of 300 patients of ultrasound proven gall bladder stones was studied for NAFLD by Fibroscan (transient elastography). Transient elastography (TE) is a noninvasive method that has been shown to be useful for the detection of liver steatosis and fibrosis. NAFLD was diagnosed based on the value of CAP (Controlled Attenuation Parameter) & degree of fibrosis was assessed based on liver stiffness measurement (LSM) value on TE. Steatosis was graded as S0, S1, S2, and S3 while fibrosis was graded as F0-F1, F1, F2, F3, and cirrhosis. Minimum cut-off CAP value for diagnosing NAFLD was 214 dB/m & significant fibrosis was taken with LSM value >7.5 kPa.RESULTSPatients of gall stone disease showed significant liver steatosis, suggestive of NAFLD in 189 patients (63%), based on CAP value; however, 111 patients (37%) did not have significant steatosis. In patients with NAFLD, 57 (30%) had mild steatosis (s1) while 39 (20.53%) & 24 (12.63%) had moderate (s2) and severe (s3) steatosis respectively. Similarity, 72 (24%) patients had significant fibrosis while 228 (76%) patients had no to insignificant fibrosis on TE, 51 (17%) patients had moderate fibrosis, while 14 (4.5%) and 8 (2.5%) patients had severe fibrosis & cirrhosis respectively.CONCLUSIONSHigh prevalence of NAFLD in patients of gall stone disease was observed. Most of the patients had mild NAFLD i.e. grade S1 steatosis & in addition, fibrosis was present in 24% patients of NAFLD with gall stone disease.

Oclusión intestinal por íleo biliar, tratamiento quirúrgico / Bowel obstruction for gall stone ileus, surgical management

Resumen Antecedentes: El íleo biliar es una rara complicación de la colecistitis crónica litiásica que representa del 1 al 3% de los casos de oclusión intestinal. Primera vez descrito por Bartolin en 1654, el íleo biliar ocurre por obstrucción crónica del conducto cístico y necrosis de la vesícula biliar, lo que puede desarrollar una fistula colecisto-entérica. Rigler en 1941 describió la tríada clásica del íleo biliar. Caso clínico: Mujer de 56 años de edad con diagnóstico de insuficiencia hepática que súbitamente presentó distención abdominal con ausencia de evacuaciones y canalización de gases. La tomografía abdominal mostró datos que sugieren el diagnóstico de oclusión intestinal, por lo que se realizó laparotomía exploradora con presencia de distención de asas. Se retiraron 2 litos por medio de enterolitotomía; evolución posquirúrgica adecuada hasta lograr estabilización hemodinámica y alta hospitalaria. Conclusiones: La presencia de íleo biliar es una rara causa de colusión intestinal que requiere de tratamiento quirúrgico para su resolución. Ee necesita un alto nivel de sospecha para su diagnóstico y manejo.

Abstract Background: Gall-stone ileus is a weird complication of the lithiasic cholecyst since it represents only 1 to 3% of the bowel obstuccion cases. It was described for the first time by Bartoin in 1654, the gall-stone ileus happens due to a cronic obstruccion in the cistic duct than causes gallbladder necrosis and a bile enteric fistula. In 1941, Rigler described the classic triad for the gall-stone ileus. Clinical case: A 56-year-old woman that had a diagnosis of hepatic failure, suddenly presented abdominal distension, constipation and obstipation. The abdominal tomography showed data that suggested a bowel occlusion, therefore, we performed an exploratory laparotomy and found distension of the bowel loops and the presence of three gall stones, that were removed with enterolitotomy. The pacient had a good posquirurgic evolution and was discharged from hospital. Conclusions: The gall-stone ileus is a rare cause for bowel occlusion that requires surgical treatment; it needs a high level of suspicion for its diagnoses and management.

Relationship between alcohol consumption and new-onset cholelithiasis: a multicentre retrospective study(A report of 77 755 cases) / 中华消化外科杂志

Objective To explore the relationship between alcohol consumption and new-onset cholelithiasis.Methods The retrospective cohort study was conducted.The data of 77 755 participants who participated health examination at the Kailuan General Hospital,Kailuan Linxi Hospital,Kailuan Zhaogezhuang Hospital,Kailuan Tangjiazhuang Hospital,Kailuan Fan'gezhuang Hospital,Kailuan Lyujiatuo Hospital,Kailuan Jinggezhuang Hospital,Kailuan Linnancang Hospital,Kailuan Qianjiaying Hospital,Kailuan Majiagou Hospital and Kailuan Branch Hospital from June 2006 to December 2015 were collected.According to definition of alcohol consumption from literature,all the 77 755 participants were allocated into the 5 groups,including 50 695 with never drinking in the never group,3 154 with alcohol withdrawal time≥ 1 year in the past group,12 410 with light drinking in the light group,1 606 with moderate drinking in the moderate group and 9 890 with heavy drinking in the heavy group.All participants received the same-order health examinations by the fixed team of doctors in 2006,2008,2010,2012 and 2014 at the same place.Epidemiological investigation,anthropometric parameters and biochemical indicators were collected.Observation indicators:(1) comparisons of clinical characteristics among the 5 groups;(2) incidence of cholelithiasis;(3) risk factors analysis affecting new-onset cholelithiasis;(4) comparisons of the fitting degree of alcohol consumption on new-onset cholelithiasis model.Measurement data with normal distribution were represented as (x)±s,and comparisons among groups were analyzed using the one-way ANOVA.The pairwise comparison and homogeneity of variance were done using the least significance difference (LSD) test.Heterogeneity of variance was analyzed by the Dunnett's T3 test.Measurement data with skewed distribution were described as M (Q),and comparisons among groups were analyzed using the rank sum test.Comparisons of count data were analyzed using chi-square test.The cumulative incidence of new-onset cholelithiasis was calculated by the Kaplan-Meier method,and comparisons of incidences among groups were done by the Log-rank test.The hazard ratio (HR) and 95％ confidence interval (CI) of different intakes of alcohol on new-onset cholelithiasis were estimated by the COX proportional hazards regression models.The fitting degree of alcohol consumption on new-onset cholelithiasis model was calculated by the likelihood ratio test and akaike information criterion (AIC).Results (1) Comparisons of clinical characteristics among the 5 groups:male,age,systolic pressure,diastolic pressure,body mass index (BMI),total cholesterol (TC),triglyceride (TG),fasting plasma glucose (FPG) and waistline and cases with diabetes,hypertension,smoking and physical exercise were respectively 33 406,(51±12)years,(130±21) mmHg (1mmHg=0.133 kPa),(83± 12)mmHg,(25±4)kg/m2,(4.93±1.13)mmol/L,1.26 mmol/L (0.90-1.88 mmol/L),(5.5±1.7)mmol/L,(86±10) cm,4 538,21 773,5 873,6 140 in the never group and 3 077,(56±12) years,(134±22)mmHg,(85±12)mmHg,(25± 3) kg/m2,(4.93 ± 1.21) mmol/L,1.29 mmol/L (0.91-1.90 mmol/L),(5.6 ± 1.8) mmol/L,(89 ±9)cm,420,1 652,856,856 in the past group and 11 859,(46±12)years,(127±19)mmHg,(82±11)mmHg,(25±3)kg/m2,(4.89± 1.15) mmol/L,1.30 mmol/L (0.89-2.01 mmol/L),(5.4± 1.4) mmol/L,(87±9)cm,891,4294,2 186,2 186 in the light group and 1 585,(58±11)years,(134±22)mmHg,(84±11)mmHg,(25±3)kg/m2,(5.06±1.21)mmoL/L,1.23 mmoL/L (0.85-1.82 mmol/L),(5.5±1.7) mmol/L,(88±9)cm,159,762,591,591 in the moderate group and 9 868,(52±9) years,(135±21)mmHg,(86±12)mmHg,(25±3)kg/m2,(5.18±1.21)mmoL/L,1.36 mmol/L (0.92-2.19 mmol/L),(5.5±1.5)mmoL/L,(88±9) cm,819,4 900,2 183,2 183 in the heavy group,showing statistically significant differences among groups [x2 =9 989.71,F=869.28,F=254.13,195.97,27.52,112.63,H(x2) =154.09,F=11.92,63.37,x2 =128.17,656.31,23 561.80,656.31,P＜0.05].(2) Incidence of cholelithiasis:all 77 755 participants were observed for (6.8±2.1)years,3 757 were diagnosed as new-onset cholelithiasis,with a cumulative incidence of new-onset cholelithiasis of 4.5％.The cumulative incidences of new-onset cholelithiasis in the never,past,light,moderate and heavy groups were respectively 5.1％,4.9％,3.7％,3.4％ and 3.3％,showing a statistically significant difference among groups (x2=83.14,P＜0.05).The cumulative incidence of new-onset cholelithiasis in the never group was significantly different from that in the past,light,moderate and heavy groups (x2 =18.34,40.58,45.41,48.44,P＜0.05).The cumulative incidence of new-onset cholelithiasis in the past group was significantly different from that in the light,moderate and heavy groups (x2 =18.72,20.47,25.41,P＜0.05).There were statistically significant differences in the cumulative incidence of new-onset cholelithiasis among the light,moderate and heavy groups (x2=8.47,12.41,P＜0.05) and no statistically significant difference between the moderate and heavy groups (x2=0.85,P＞0.05).(3) Risk factors analysis affecting new-onset cholelithiasis:results of COX proportional hazards regression models showed that risks of new-onset cholelithiasis in the light,moderate and heavy groups were reduced compared with never group after adjustment of gender,age,TC,TG,BMI,hypertension,diabetes,smoking and physical exercise (HR=0.88,0.82,0.73,95％CI:0.79-0.98,0.76-0.89,0.64-0.83,P＜0.05).(4) Comparisons of the fitting degree of alcohol consumption on newonset cholelithiasis model:multivariate model was constructed after adding risk factors of gender,age,BMI,TG,TC,hypertension,diabetes mellitus,smoking and physical exercise,and-2Log L and AIC were 76 331.83 and 76 353.83 for the multivariate model.Then drinking variable was added into multivariate model,and the-2Log L and AIC of the multivariate model+drinking model were 76 307.86 and 76 337.86,respectively,with statistically significant differences (x2=23.97,P＜0.05).Conclusion Alcohol consumption is an independent protective factor for new-onset cholelithiasis,and the risk of cholelithiasis is decreased with increasing alcohol intake.

Percutaneous transhepatic removal of gall-stone technique for the treatment of common bile duct stones: initial experience in 25 patients / 介入放射学杂志

Objective To discuss the clinical application of percutaneous transhepatic removal of gall-stone technique in treating common bile duct (CBD) stones.Methods Between January 2013 and January 2015,a total of 25 patients with CBD stones underwent lithotomy procedure via percutaneous transhepatic route.First,under ultrasound or fluoroscopy guidance percutaneous transhepatic cholangiography (PTC) was performed with subsequent placement of an 8 F rsheath;then,a balloon of 8-12 mm diameter was employed to dilate the papilla;mechanical lithotripsy was adopted when the stone size exceeded 12 mm;finally,through guide-wire exchange technique the stone-retrieval balloon was used to push the stones into the intestinal tract through the sphincter of duodenal papilla.Results The reasons to receive percutaneous transhepatic removal of gall-stone technique in the 25 patients included previous gastrointestinal surgery (n=18),endoscopic treatment failure (n=3),unwilling to receive endoscopic treatment (n=3),and other reasons (n=1).Successful removal of stones was accomplished in all 25 patients.After the treatment,complications occurred in 3 patients (12％),including fever (n=2) and liver abscess formation (n=1).The patients were followed up for 0.5-3 years;two patients died of tumor recurrence and metastasis,and one patient developed recurrence of common bile duct stones.No reflux cholangitis occurred.Conclusion For the treatment of CBD stones,percutaneous transhepatic removal of gall-stone technique carries higher technical success rate with lower incidence of complications,therefore,this technique can be used for the patients who are not suitable for endoscopic treatment or in whom endoscopic treatment failed.

The Effect of Gallstone Presentation on Treatment Outcome in Symptomatic Cholelithiasis

Introduction: Gall stone disease (GSD) is a common surgical problem. Surgical treatment of  asymptomatic GSD is still controversial. Complicated GSD has varied presentation and contributes substantially to healthcare costs and may be life threatening. The present study is aimed to know the effect of gall stone presentation on treatment outcome. Methodology: This is a retrospective study conducted in a tertiary health care centre. All patients who underwent cholecystectomy (open or laparoscopic) were included in the study and were grouped in uncomplicated (Group A) and complicated group (Group B), depending upon their presentation. Treatment outcome was analysed for various measures i.e. type of admission (emergency or elective), length of hospital stay, postoperative complications, type of surgery and mortality. Observations: Out of the 202 patients, 109 (53.9%) were in group A and 93 (46.1%) were in group B. Acute cholecystitis comprised 30.1% of complicated GSD, whereas gall stone pancreatitis, choledocholithiasis, mucocele, empyema gall bladder, perforation and gall stone ileus comprised 6.9%, 2.9%, 3.9%, 0.9%, 0.4% and 0.4% respectively. Comparatively, patients with uncomplicated GSD were admitted electively, were mostly managed laparoscopically and had lower incidence of post-operative complications and hence shorter length of hospital stay and lower treatment cost. Conclusion: Most of the patients who present early in course of GSD have better treatment outcome. We recommend early elective laparoscopic surgery for all patients who present with initial symptoms of GSD.

Etiology, age and sex distribution, investigations and treatment of gallstone pancreatitis

Background: Acute pancreatitis occurs in only 3-7% of patients with gallstones. But gallstones were implicated in about 27% cases of acute pancreatitis reported in a decade prior to 1980. The relative risk of developing acute pancreatitis varies from country to country, and within a given country it is influenced by socio-economic, ethnic, and cultural factors. The present study evaluated the incidence of the disease, age-sex distribution, clinical manifestations methods, and management of gallstone pancreatitis. Aim and objectives: To diagnose a case of gallstone pancreatitis by various investigations like blood investigations, USG or by CT scan, age-sex distribution, to observe the varied clinical presentations of biliary pancreatitis with regards to symptoms and signs, to study the management protocol of gallstone pancreatitis. Material and methods: 50 cases of gallstone pancreatitis were studied during the period from May 2012 to July 2014, from all surgical units at our institute. Inclusion criteria: All patients admitted in surgical wards in a given particular unit who have diagnosed as having gallstone pancreatitis. Exclusion criteria: Patients having pancreatitis other than biliary cause. This study included all the age groups and both the sex. Results: In our study, most (34%) of male patients at the age group of 50-70 years, biliary pancreatitis was more predominant. Most (34%) of female patients at the age group of 40-60 years had biliary pancreatitis. In our study, most (92%) of the patient’s serum amylase was 3 fold above normal value,alkaline phosphatase was raised in 88% of patients, 68% of them had increased AST, and 22% of them had had elevated serum bilirubin levels. Normal value of serum amylase ranges from 40 to 140 Naik N, Patel G, Parmar H. Etiology, age and sex distribution, investigations and treatment of gallstone pancreatitis. IAIM, 2016; 3(1): 46-50. Page 47 U/L, Alkaline phosphatase from 45 to 115 U/L and AST from 8 to 48 U/L. In our study, out of 50 patients, 28 patients underwent laparoscopic cholecystectomy and 8 patients underwent open cholecystectomy during same admission. In 9 patients endoscopic retrograde cholangiopancreatography (ERCP) plus endoscopic sphincterotomy (ES) was done and remaining patients managed conservatively. Conclusion: Gallstone pancreatitis represents the most severe form of disease. The diagnosis is based in history and physical examination, an elevation of serum amylase 3 fold above the normal level, and ultrasound and CT scans. Endoscopic retrograde cholangiopancreatography is one of the tools in less certain cases of the absence of an agent that can abort progression of the disease; therapy should consist of adequate resuscitation, nutritional support, and careful monitoring to detect early complications.

Diagnosis and analysis of residual gallbladder stone with choledocholithiasis / 中国基层医药

Objective To investigate the diagnosis/misdiagnosis reason/treatment of residual gallbladder stone with choledocholithiasis.Methods The clinical data of 34 patients with residual gallbladder,16 cases of them suffered from choledocholithiasis additionally were retrospective analyzed.Results 14 cases were treated by residual cholecystectomy +choledochotomy +T -tube drainage,2 cases were were treated by choledochotomy + T -tube drainage.Preoperative misdiagnosis of residual gallstones rate was 56.3% (9 /16 ),7 cases were found residual gallstones during operation.The other 2 cases were misdiagnosed residual gallstones.The rate of intraoperative and postoperative misdiagnosis was 12.5% (2 /16 ).18 cases with residual gallstones,16 cases underwent residual cholecystectomy,2 cases who were suspected with choledocholithiasis underwent residual cholecystectomy +choledo-chotomy,T -tube drainage.18 cases had no preoperative and postoperative misdiagnosis.Conclusion The clinical symptom of residual gallbladder stone with choledocholithiasis was similar to residual gallstones,often characterized by upper abdominal pain,fever,chills,jaundice,abdominal distension and other symptoms.It is difficult for preoperative imageological diagnosis that less than 3 cm residual gallbladder and small stones.When choledocholithiasis at the same time,needing more intraoperative careful dissect cystic duct and common bile duct,completes the cystic duct and common bile duct exploration,reducing misdiagnose residual gallstones.

Choledochocele containing a stone mistaken as a distal common bile duct stone / 영남의대학술지

A choledochocele is an expanded sac of the duodenal side of the distal common bile duct (CBD), and is categorized as a type III choledochal cyst. Unlike other choledochal cysts, it can be easily overlooked because of its very low prevalence, non-specific clinical symptoms, and lack of distinctive radiological findings. However, a patient having a repeated pancreaticobiliary disorder with an unknown origin, frequent abdominal pain after cholecystectomy, or repeated non-specific gastrointestinal symptoms can be suspected as having a choledochocele, and a more accurate diagnosis can be achieved via endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound. Because it rarely becomes malignant, a choledochocele can be treated via endoscopic sphincterotomy (EST) and surgical treatment. The authors were able to diagnose choledochocele accompanied by a stone in a patient admitted to the authors' hospital due to cholangitis and pancreatitis. The patient's condition was suspected to have been caused by a distal CBD stone detected via multiple detector computed tomography and ERCP, and was successfully treated via EST.

Effect of gender, biochemical parameters & parathyroid surgery on gastrointestinal manifestations of symptomatic primary hyperparathyroidism.

Background & objectives: Information on gastrointestinal manifestations and then response after curative parathyroid surgery is scarce in symptomatic primary hyperparathyroidism (PHPT). This study was carried out to analyse gastrointestinal manifestations in patients with PHPT and their associations with biochemical parameters. Methods: This retrospective study included 153 patients with symptomatic primary hyperparathyroidism (PHPT). The signs and symptoms pertaining to gastrointestinal system were analyzed. The difference of symptoms between men and women and difference in biochemical parameters in presence of different symptoms were evaluated. The relationship between serum calcium, phosphate and parathyroid hormone (PTH) levels with presence of gallstone and pancreatitis was also studied. Result: Of the 153 patients, 46 (30%) were men. The mean age was 39.2 ± 13.9 yr. Nearly 80 per cent of PHPT patients had at least one symptom/ sign related to gastrointestinal system. The most common gastrointestinal manifestations were abdominal pain 66 (43%), constipation 55 (36%), and nausea/or vomiting 46 (30%). Nearly one-fourth 34 (22%) of patients had a history of either gallstone disease or cholecystectomy or both. The prevalence of gallstone disease was higher in women (P<0.05). Imaging and biochemical evidence of pancreatitis was found in 27 (18%) patients. Pancreatitis was more common in men compared to women (P<0.05) despite the higher prevalence of gallstones in women. Serum calcium, phosphate or PTH levels were not associated with high risk for gallstone disease, however, serum calcium (P<0.05) was associated with 1.3 times higher risk of developing pancreatitis. In majority of patients, gastrointestinal manifestations resolved within three months of curative parathyroidectomy. Except two patients, none had recurrence of pancreatitis. Interpretation & conclusions: The study revealed that the gastrointestinal symptoms were common in patients with symptomatic PHPT. There was not much gender difference in gastrointestinal symptoms except higher occurrence of gallstones in women and pancreatitis in men. There was no difference in biochemical profile between those who had and did not have gastrointestinal symptoms.

Influencing factors in elderly patients with schistosomiasis liver disease com-bined with gallbladder diseases / 中国血吸虫病防治杂志

Objective To understand the status of elderly patients with schistosomiasis liver diseases combined with gallblad-der diseases,and explore the influencing factors. Methods A total of 280 elderly patients with schistosomiasis liver disease were divided into two groups,198 cases of chronic liver fibrosis and 82 cases of liver cirrhosis,and the results of their gallbladder ultra-sound and liver function examinations were analyzed statistically. Results Among the 280 cases,157 patients were combined with gallbladder diseases(56.1%),including gallbladder wall thickening(28.2%,79/280),cholecystolithiasis(13.6%,38/280),cholecystitis(11.1%,31/280),and gallbladder polyp(3.2%,9/280). The incidence rates of gallbladder wall thickening, cholecystitis and cholecystolithiasis in the schistosomiasis patients with cirrhosis were significantly higher than those in the schisto-somiasis patients with liver fibrosis(χ2=4.568,P<0.05). Conclusion The main influencing factors of schistosomiasis liver dis-ease combined with gallbladder diseases are the age,the course of the disease,liver cirrhosis and the portal hypertension degree.

A Case of Choledocho-Duodeno-Colonic Fistula / 대한소화기내시경학회지

Biliary-enteric fistula is a rare disease, and the common causes of biliary-enteric fistula are gallstone, peptic ulcer, malignancy and trauma. It is known that the most common type of biliary-enteric fistula is the cholecysto-duodenal fistula, yet the combination of choledocho-duodeno-colonic fistula is a rare finding. A 78-year-old woman was admitted because she had suffered with right upper quadrant pain, a febrile sense and chills for 2 days. We confirmed the choledocho-duodeno-colonic fistula by performing gastroduodenoscopy, abdominal CT and an upper GI series. So, we report here on an usual case of choledocho-duodeno-colonic fistula, along with a review of the relevant literatures.

Infrared spectrum analysis on pearly gallstone discharged with TMF / 中国医学物理学杂志

The pearly gallstone was discharged after Treatment with Magnetic Field (TMF). The pearly gallstones are measured with FT-IR spectrometer. The results demonstrate that mostly composition of this gall-stones is cholesterol and intermixture with some protean and inorganic calcium salt. Nature pearls is mostly composed with calcium carbonate. Their compositions are different. The pearly gall-stones show sandwich of cholesterol crystal in structure.

Effect of Reconstruction-Method after Radical Subtotal Gastrectomy on Gall Bladder Motility: A Prospective Study, Short Term Follow-up

BACKGROUND: Several clinical observations suggest that the incidence of gallbladder stone increases after gastric surgery. The mechanism is not clear, but many investigators have proposed that the cause may be decreased gallbladder motility due to vagal denervation. However, the authors observed a increased-incidence of gallbladder stone in Billroth II anastomosis (gastrojejunostomy) and an unchanged- incidence of that in Billroth I anastomosis (gastroduodenostomy) after a radical subtotal gastrectomy. METHODS: We studied the change in the motility of gallbladder after gastrectomy, prospectively. Gallbladder ejection fraction was compared pre- and postoperatively by gallbaldder scintigraphy with DISIDA. RESULTS: 32 patients were involved in this study. They were all thought to have early gastric cancer, preoperatively and received a radical subtotal gastrectomy. 20 patients underwent a Billroth I anastomosis and 12 patients, Billroth II anastomosis after gastrectomy. The mean ejection fractions of the Billroth I group were 75.9% and 46.4%, pre- and postoperatively, and those of the Billroth II group were 78.2% and 45.3%. There were no difference of ejection fractions between the two groups. However a significant difference existed between the preoperative and the postoperative ejection fractions in each group. CONCLUSIONS: These findings may mean that the gastrectomy (it means vagal denervation) may be the major cause of the decreased gallbladder motility and that the reconstruction method after a gastrectomy may have no significant effect on gallbladder motility.

Clinical Analysis of Laparoscopic Cholecystectomy in Complicated Cholelithiasis

Laparoscopic cholecystectomy has been popularized all over the world as the treatment of choice for unnecessory symptomatic or asymptomatic gall stones. Initially, this surgery was applied to limited indications, but nowadays the indications of the surgery have been expanded to include severe, inflamed, complicated patients with gall stones, which used to be thought of as contraindications in the past. Surgeon,s technical improvement and newly devised surgical instruments made it possible to expand the limit of surgical indications for laparoscopic cholecystectomy. However, anatomical disorientation due to severe inflammed gall bladder is still the drawback to the possible occurrence of laparoscopic bile duct injury and bleeding. We have a clinical analysis of 32 cases of laparoscopic cholecystectomy for acute cholecystitis or G.B.empyema, surgical time,safety and case were evaluated. Two patients were converted to open laparotomy because of intraoperative bile duct injury and anatomical disorientation by hepatic flexure colonic interposition. As a result, we suggest that even in patients with subphrenic abscess or bile peritonitis secondary to G.B.empyema could be the indications for the laparoscopic cholecystectomy if surgeon's ability or patient's condition allow it.