Establishing normal gallbladder volume: a comparative study of dual energy computed tomography and ultrasound measurements in a North Indian population

Background: The gallbladder, a critical component of the biliary system, plays a vital role in bile storage and digestion. Dysfunction in the gallbladder often results in gallstone formation, leading to significant healthcare burdens worldwide. Gallstone disease and gallbladder carcinoma are major health concerns, particularly in regions like India, where prevalence is high and poorly understood. Methods: This study aims to establish the normal baseline volume of the gallbladder using dual-energy computed tomography (DECT) and compare it with measurements obtained via ultrasound (USG). The cross-sectional study conducted at Era's Lucknow medical college and hospital involved 265 individuals aged 18-80 years with non-gallbladder-related abdominal conditions. Results: Final results showed the mean gallbladder volume to be 29.33�70 cm3 by DECT and 27.40�58 cm3 by USG, with DECT measurements being on average 1.93 cm3 higher. A significant association was found between gallbladder volume and obesity, but not gender. Conclusions: The findings suggest DECT provides slightly higher and potentially more accurate measurements of gallbladder volume compared to USG. These insights contribute to a better understanding of gallbladder physiology and the implications of its volume in various pathologies, emphasizing the need for further studies with larger sample sizes to validate these observations.

A micro bacteriological culture assessment of the histopathological alterations in liver and bile in gallstone disease

Background: The present investigation aims to evaluate both the intensity and occurrence of hepatic impairment in patients afflicted with gallstone disease, examining the involvement of bacteria in the progression of these alterations. Methods: This prospective observational investigation was carried out on 189 patients scheduled for open or laparoscopic cholecystectomy at IGIMS in Patna, Bihar, India. In all the patients, laboratory and radiological investigations were performed. A healthy section of the liver border near the gallbladder fossa was chosen and grasped with non-traumatic forceps. Approximately 1 cm of the liver edge was excised using scissors and forwarded for histopathological analysis. Results: An examination of 189 liver biopsy specimens revealed that 87 (46%) patients showed no abnormalities, while 102 patients (54%) exhibited one or more changes. Upon analysing the liver biopsy samples from the control cohort (41 patients) during autopsy, 37% of the cases were identified to display hepatic lipidosis, while 48% of the cases showed lymphocytic invasion. Importantly, no cases of acute inflammatory changes were detected in the control cohort. Microbiological analysis was conducted on 96 patients, of which 33 (34%) showed positive cultures, with one or more microorganisms isolated from either the biliary tract or liver. Among these, 74% (24 cases) originated from the bile or gallbladder, while 26% (9 cases) were isolated from the liver. Conclusions: Gallstone disease induces significant liver histological changes, notably more prevalent in patients with prolonged symptoms. The present study clearly identifies this and underscores the importance of timely diagnosis and intervention for the effective management of this disease.

Prognosis of congenital bile duct cysts after cyst resection and risk factors analysis of postoperative biliary calculus / 中华肝胆外科杂志

Objective:To study the prognosis of congenital bile duct cysts following cyst resection, and to analyze the risk factors associated with the development of postoperative biliary calculus.Methods:Clinical data of 149 patients with congenital bile duct cysts undergoing surgery in the First Affiliated Hospital of Nanjing Medical University from May 2004 to January 2022 were retrospectively analyzed, including 59 males and 90 females, with a median age of 32 (21, 47) years old. Patients were divided into two groups: the stone group ( n=51, biliary calculus occurred during the follow-ups after surgery) and non-stone group ( n=98). Clinical data such as gender, age, medical history, cyst type, biliary calculus, anastomotic stenosis and occurrence of cancer were compared. All patients were followed up via telephone consultations. A logistic regression analysis was used to identify the risk factors associated with the occurrence of biliary calculus after surgery. Results:The duration of the follow-ups was 120 (24, 211) months. The observed incidence of postoperative biliary calculus, anastomotic stricture, and cancer in the patients were 34.2% (51/149), 8.7% (13/149), and 4.7% (7/149), respectively. The logistic regression analysis indicated that incomplete cyst resection ( OR=3.332, 95% CI: 1.221-9.094) and postoperative anastomotic stenosis ( OR=13.300, 95% CI: 2.586-68.401) were associated with a higher risk of biliary calculus formation after cystectomy (all P<0.05). Conclusion:Patients with congenital bile duct cysts suffer a high risk of biliary calculus formation after cystectomy. The residual cyst and postoperative anastomotic stenosis are independent risk factors for biliary calculus after surgery.

Research progress in etiology of acute gallstone pancreatitis / 中华肝胆外科杂志

Acute gallstone pancreatitis (AGP) is a kind of acute pancreatitis caused by gallstones. The etiology of AGP is complex, and the anatomic basis and initiating factors have a synergistic effect on its pathogenesis, which needs to be studied jointly. The way of the confluence of pancreaticobiliary ducts, dilated main pancreatic duct, the relatively narrow opening of duodenal papilla and small stones or microlithiasis may be involved in the pathogenesis of AGP, in which small stones are the most important. Etiological diagnosis and clinical treatment of AGP should be carried out simultaneously. The timely selection of treatment methods for different causes can alleviate the patient's condition to the greatest extent and reduce the cost of treatment. At present, it is difficult to unify the prediction indexes of AGP. Meanwhile, the pathogenesis and related prophylaxis and treatment also need to be studied. In this paper, the anatomic basis, initiation factors, pathogenesis and self-defense of AGP were analyzed to provide a new perspective for its treatment.

Association between dietary inflammatory index and gallstone disease among middle-aged and elderly population / 预防医学

Objective@#To analyze the association between dietary inflammatory index (DII) and gallstone disease among middle-aged and elderly population, so as to provide the evidence for the prevention and control of gallstone disease.@*Methods@#Baseline survey data were collected from the Shanghai Women's Health Study (SWHS) and Shanghai Men's Health Study (SMHS), including demographic information, gallstone disease prevalence and dietary habits. DII was calculated using 29 kinds of food parameters associated with common inflammatory biomarkers and food intake data of residents. A multivariable logistic regression model was used to analyze the association between dietary inflammatory index and gallstone disease.@*Results@#A total of 132 312 individuals were included in the analysis. There were 59 627 males and 72 685 females. Among males, the median age was 53.07 (interquartile range, 9.73) years, 41 544 cases (69.67%) had an educational level of middle school, 4 463 cases (7.48%) had gallstone disease, and DII was -6.46 to 5.59. Among females, the median age was 50.27 (interquartile range, 9.05) years, 47 380 cases (65.19%) had an educational level of middle school, 8 090 cases (11.13%) had gallstone disease, and DII was -6.44 to 4.93. Multivariable logistic regression analysis showed that after adjusting for age, educational level, income level, smoking, alcohol consumption, tea consumption, physical activity and menopausal status (only for females), DII (OR=1.095, 95%CI: 1.002-1.196) was associated with an increased risk of gallston disease among males, but no statistically association was found among females (P>0.05).@*Conclusion@#DII might be associated with an increased risk of gallstone disease among middle-aged and elderly population.

Previsores de falha da colangiopancreatografia retrógrada endoscópica na limpeza de cálculos do ducto biliar durante o procedimento inicial - Um estudo prospectivo / Predictors of failure of endoscopic retrograde cholangiopancreatography in clearing bile duct stones during index procedure - a prospective study

ABSTRACT Background: Common bile duct (CBD) stones are known to complicate 10-15% of gallstone diseases. Endoscopic retrograde cholangiopancreatography (ERCP) is the therapeutic modality of choice for bile duct clearance in CBD stones but may fail to achieve stone clearance. This prospective study was done to identify the predictors of failure of CBD clearance with ERCP. Objective: This prospective study was done to identify the predictors of failure of CBD clearance with ERCP. Methods: All consecutive patients with bile duct stones undergoing ERCP at a tertiary care center were prospectively included from October 2020 to October 2021. The study's primary outcome was to identify and analyze factors that could predict the failure of complete CBD clearance. Results: A total of 120 patients (50.8% males, median age: 53.5 years) were included in the final analysis. Successful clearance of CBD stones during the index procedure was achieved in 70% of patients. At a cut-off stone diameter of >10.5 mm and CBD diameter of >12.5 mm, the AUC was 0.890 and 0.884, respectively, to predict failed clearance of CBD. On multivariate analysis, stone diameter ≥15 mm [odds ratio (OR) 16.97, 95% confidence interval (CI): 1.629-176.785], location of stones in hepatic ducts (OR 7.74, 95%CI: 2.041-29.332), presence of stricture distal to stone (OR 6.99, 95%CI: 1.402-34.726) and impacted stone (OR 21.61, 95%CI: 1.84-253.058) were independent predictors of failed bile duct clearance. Conclusion: Stone size and location are independent predictors of failed bile duct clearance. The endoscopist should consider these factors while subjecting a patient to biliary ductal clearance to plan additional intervention.

RESUMO Contexto: Cálculos do ducto biliar comum (CDC) são conhecidos por complicar 10-15% das doenças de cálculos biliares. A colangiopancreatografia retrógrada endoscópica (CPRE) é a modalidade terapêutica de escolha para a limpeza do CDC, mas pode falhar na sua remoção. Objetivo: Este estudo prospectivo foi realizado para identificar os previsores de falha na limpeza do CDC com CPRE. Métodos: Pacientes consecutivos com cálculos no ducto biliar submetidos a CPRE em um centro de atendimento terciário foram incluídos prospectivamente de outubro de 2020 a outubro de 2021. O principal resultado do estudo foi identificar e analisar fatores que poderiam prever a falha na limpeza completa do CDC. Resultados: Um total de 120 pacientes (50,8% homens, idade média: 53,5 anos) foram incluídos na análise final. A limpeza bem-sucedida dos cálculos de CDC durante o procedimento inicial foi alcançada em 70% dos pacientes. Com um diâmetro de corte de cálculos >10,5 mm e de diâmetro de CDC de >12,5 mm, a AUC foi de 0,890 e 0,884, respectivamente, para prever a falha na limpeza do CDC. Na análise multivariada, diâmetro da cálculos ≥15 mm [razão de chances (OR) 16,97, intervalo de confiança de 95% (IC): 1,629-176,785], localização dos cálculos nos ductos hepáticos (OR 7,74, IC95%: 2,041-29,332), presença de estreitamento distal ao cálculo (OR 6,99, IC95%: 1,402-34,726) e cálculo impactado (OR 21,61, IC95%: 1,84-253,058) foram previsores independentes de falha na limpeza do ducto biliar. Conclusão: O tamanho e a localização dos cálculos são previsores independentes de falha na limpeza do ducto biliar. O endoscopista deve considerar esses fatores ao submeter um paciente à limpeza ductal biliar para planejar intervenção adicional.

Intestinal Obstruction Secondary to Gallstone Ileus in a Patient with Cholangitis: Case Report

Gallstone ileus manifests as intestinal obstruction. It occurs due to the passage of a stone and its subsequent lodging in the lumen of the digestive tract. The diagnosis is confirmed by imaging; the gold standard is abdominal tomography. Management is based on the extraction of the intraluminal calculus in one or more surgical times, depending on the patient's condition. We present the case of a patient with multiple comorbidities who showed a picture of cholangitis complicated by gallstone ileus and successfully treated with enterolithotomy. Surgical management is controversial since the optimal approach for these patients has not been established.

El íleo biliar se manifiesta como una obstrucción intestinal, se presenta por el paso de un lito y su posterior alojamiento en el lumen del tubo digestivo. El diagnóstico se confirma mediante imagenología, el patrón de oro es la tomografía abdominal. El manejo se fundamenta en la extracción del cálculo intraluminal en uno o más tiempos quirúrgicos, según el estado del paciente. Se presenta el caso de un paciente con múltiples comorbilidades, que debuta con un cuadro de colangitis complicada por íleo biliar, tratado exitosamente con enterolitotomía. El manejo quirúrgico es controversial, ya que no se ha establecido el abordaje óptimo para estos pacientes.

Íleo biliar: análisis de 21 casos / Gallstone ileus: analysis of 21 cases

RESUMEN Antecedentes : el íleo biliar es una complicación infrecuente de la litiasis vesicular, observada más comúnmente en mujeres añosas. Es causada por la migración, a través de una fístula bilioentérica, de un cálculo que produce la obstrucción del tránsito intestinal, que requiere tratamiento quirúrgico. Objetivo : describir las variables preoperatorias, intraoperatorias y posoperatorias de una serie de casos de íleo biliar y la incidencia de íleo biliar recurrente. Material y métodos: se realizó un estudio retrospectivo observacional de pacientes operados con abdomen agudo obstructivo por íleo biliar entre enero de 2009 y diciembre de 2021. Las variables estudiadas fueron: estudios por imágenes, comorbilidades, vías de abordaje quirúrgico, tipo de cirugía, morbimortalidad y recurrencia del íleo. Resultados : sobre 667 pacientes que ingresaron con obstrucción intestinal, 21 tenían íleo biliar (3,1%). El diagnóstico se realizó por tomografía en el 80% de los casos. El abordaje quirúrgico fue por laparotomía en 20 casos y 1 por laparoscopia convertida. La cirugía más utilizada fue la enterotomía con enterorrafia en 18 casos. El tratamiento de la obstrucción fue la cirugía inmediata, mientras que el de la fístula biliar fue diferido en la mayoría de las oportunidades, debido a que el riesgo de tratarla en el momento era muy elevado. La morbilidad fue del 38% y la recurrencia del íleo biliar 4,7%. No se registró mortalidad. Conclusión : el íleo biliar fue una patología infrecuente, que pudo ser correcta y oportunamente diagnosticada y tratada con cirugía, con una baja incidencia de íleo biliar recurrente.

ABSTRACT Background : Gallstone ileus is a rare complication of cholelithiasis and mainly affects elder women. It is caused by gallstone migration through a cholecystoenteric fistula producing bowel obstruction, with the need for surgical treatment. Objective : The aim of this work was to describe the preoperative, intraoperative and postoperative variables of a case series of gallstone ileus and the incidence of recurrent gallstone ileus. Material and methods : We conducted an observational and retrospective study of patients undergoing surgery due to acute bowel obstruction caused by gallstone ileus between January 2009 and December 2021. The variables analyzed were imaging tests, comorbidities, surgical approach, type of surgery, morbidity and mortality and recurrent ileus. Results : Of 667 patients admitted with bowel obstruction, 21 had gallstone ileus (3.1%). The diagnosis was made by computed tomography scan in 80% of the cases. The surgical approach was laparotomy in 20 cases and 1 patient undergoing laparoscopy required conversion. Enterotomy with enterorrhaphy was the most common procedure used in 18 cases. The obstruction was treated by immediate surgery, while the biliary fistula was deferred in most cases because the risk of immediate treatment was very high. Morbidity was 38% and recurrence of gallstone ileus 4.7%. No deaths were reported. Conclusion : Gallstone ileus was a rare condition that was correctly diagnosed and timely treated with surgery, with a low incidence of recurrent gallstone ileus.

A typical presentation of a rare complication of cholelithiasis: Bouveret syndrome

Bouveret syndrome (BS) is an exceptionally rare variant of gallstone ileus, specified by gastric outlet obstruction resulting from migration of a large gallstone through the bilio-enteric fistula and is impacted in the pylorus or duodenum. We present an atypical case of BS. A 60-year old male came in Era’s Lucknow medical college who had undergone multiple diagnostic procedures (x-ray kidney ureter bladder, ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, and endoscopy) (MRCP) for his unusual presentation of right lower abdominal pain without any signs or symptoms of gastric outlet obstruction (nausea or vomiting). Initial attempts of endoscopic retrieval of stone with extracorporeal lithotripsy were performed as first-line treatment which had failed, therefore a successful surgical extraction of stone by enterolithotomy was attempted without cholecystectomy.

Case series of gallstone ileus: only enterolitotomy, one stage or two stage surgery?

Biliary ileus is a rare disease and an infrequent cause of intestinal obstruction, occasionally occurs in frail elderly patients and has a certain predilection for the female sex. The diagnosis is complex and requires a high clinical suspicion and complementary examinations such as abdominal radiography and contrasted abdominal tomography. Treatment should be individualized according to the clinical characteristics of each patient, with the alternatives being resolution only by enterolithotomy, one stage surgery and two stage surgery. We report 3 cases of biliary ileus, each one managed with a different surgical procedure. The decision was aimed at resolving the intestinal obstruction by enterolithotomy, and the definitive management was performed according to the clinical characteristics of each patient; however, there is no consensus or algorithm that recommends the ideal surgical technique. The recommended surgical procedure for the resolution of biliary ileus will be discussed.

Outcome of Laparoscopic Cholecystectomy in a District Level Hospital

Background: Laparoscopic cholecystectomy is a type of surgery that uses smaller incision than open cholecystectomy. LC has been performed as outpatient procedure for many years. Few studies have been conducted with primary focus on patient acceptance and preferences in terms of safety and satisfaction. We tried to explore its feasibility in otherwise healthy individuals undergoing laparoscopic cholecystectomy. The aim of the study of laparoscopic cholecystectomy is significantly affected by acute cholecystitis. Mechanical, biochemical, and bacteriological factors which are believed to participate in this inflammatory process are responsible for the different pathological processes observed in acute cholecystitis and in symptomatic cholelithiasis. Material & Methods: Data from 57 patients between the age group 20 to 70 years with cholelithiasis who underwent laparoscopic cholecystectomy in a private Hospital, Madaripur, Bangladesh from April 2018 to June 2020 as ambulatory surgery (hospital stay 23 Hours) with or without overnight stay were analyzed. Complications, admissions and readmissions, patient satisfaction and treatment expenditure were assessed. Results: There were 48 (84.2%) female and 9 (15.8%) male with a median age of 42 years. Only 2.4% patients required readmission while 9.2% patients had unplanned admission. 76.4% percent patients were highly satisfied with the procedure. Treatment cost was about 15% lower than routine inpatient operation. Conclusion: Laparoscopic cholecystectomy is safe and feasible. LC can be performed as an outpatient procedure with a low rate of complications and admissions/readmissions. Patient acceptance in terms of satisfaction is high.

Preclinical evaluation of Hibiscus cannabinus Linn. in the treatment of urolithiasis and cholelithiasis / 数字中医药（英文）

@#【Objective】  To investigate the therapeutic effect of Hibiscus cannabinus Linn. (H. cannabinus) leaves on cholelithiasis and urolithiasis. 【Methods】  The study evaluated the effect of aqueous leaf extract of H. cannabinus on thiouracil and cholesterol cholic acid diet induced cholelithiasis in BALB/c mice and ethylene glycol induced urolithiasis in Wistar rats. Three doses of aqueous extract (40, 80, and 160 mg/kg) were selected to evaluate the effectiveness in cholelithiasis in mice; another three doses of aqueous extract (400, 800, and 1 600 mg/kg) were administered for evaluating the effect on urolithiasis in rats. Biochemical parameters such as biliary cholesterol, biliary phospholipid, and bile acid were determined in cholelithiasis model. Similarly, 24-hour urine output, urinary parameters such as creatinine, uric acid, protein, urea, presence of calcium oxalate crystals, red blood cells (RBCs), and pyuria were determined in urolithiasis model. 【Results】  Statistically significant differences were noted in the biliary and urinary parameters after administrating three test doses of H. cannabinus aqueous extract (P < 0.05). 【Conclusion】 H. cannabinus was found to be effective against high fat lithogenic diet urolithiasis and cholelithiasis.

Disputes and thinking on the clinical diagnosis and treatment of asymptomatic gallstones / 国际外科学杂志

Cholecystolithiasis is a common clinical disease, which can be secondary to cholecystitis, cholangitis, pancreatitis and gallbladder cancer. Many patients with gallstone have no obvious clinical symptoms such as biliary colic. Some patients are indeed asymptomatic because there are not obstruction and inflammation. However, some patients have no symptoms due to ignorance, mistaken for stomach pain, enteritis, etc. Some patients have no symptoms because of insensitivity and insufficient perception. For other patients with abnormal gallbladder morphology and structure, non-functional gallbladder must be no pain. To clarify the concept, diagnosis and classification of asymptomatic gallstones according to pathophysiological stages is conducive to the development of personalized management strategies. According to guidelines formulated by different periods, different regions and different medical institutions, there are many controversies regarding the management of asymptomatic gallstones, including regular follow-up, drug treatment, surgical resection or gallblades-saving lithotomy. Reasonable personalized diagnosis and treatment requires more in-depth basic research evidence.

Progress in risk factors for gallstone formation and prevention strategies for stony stage / 国际外科学杂志

Gallstone is a common and frequent disease and frequent incidence, secondary infection and cancer seriously affect the health of patients. Academic organizations in different regions have issued multiple guidelines and consensus to promote the normative diagnosis and treatment of gallstones. However, in clinical practice, most symptomatic gallstones are treated, while the formation and prevention process of gallstones are ignored, making the concept of treating without a disease has not been strengthened.This article reviews the risk factors and mechanisms of gallstone formation, and points out the importance of effective prevention during stone formation. In the stage of gallstone formation, the high risk factors of stone formation can be analyzed through two aspects of injury factors and protective factors, and the high risk groups of stone formation can be screened out. According to the pathophysiological progression of gallstones, personalized prevention and follow-up strategies can be developed for the stone formation stage of gallstones.

Ayurvedic Management of Cholelithiasis - A Case Study

Cholelithiasis (gallstone formation) is a common Gastrointestinal disorder. The disease Cholelithiasis has not been described directly in Ayurvedic classics. The word Ashmari is described only in the context of Ashmari (urinary calculi). Surgery is the most common form of treatment for gall stones, however the fact that surgically removing gallstones requires the removal of an entire organ has led to a growing interest in non-surgical treatment. But so far as the medical management of gall stone is concerned, it is not up to the mark in allopathic system. Hence our article is a step in the direction of making an availability of a safe and effective non-surgical management of Cholelithiasis. A 35-year-old female patient reported to OPD Bangalore, with the complaints of severe pain abdomen, anorexia, distension of abdomen and vomiting. The patient was diagnosed as cholelithiasis with physical symptoms and with the help of all investigation. Oral medications like Arogyavardini vati, Varunadi Kashaya, Yavakshara and Katuki Churna was administered to the patient for 1 month and follow up was done after 3 months of treatment, a significant response was observed over clinical symptoms and USG reports

Terapia de presión negativa para el manejo de abdomen catastrófico secundario a íleo biliar / Negative Pressure Therapy for Managing Catastrophic Abdomen following Gallstone Ileus

Introducción: El abdomen catastrófico o abdomen hostil es una entidad quirúrgica de gran importancia por la pérdida de los distintos espacios entre los órganos de la cavidad abdominal y las estructuras de la cavidad abdominal. Estas alteraciones producen cambios anatómicos grandes por un síndrome adherencial severo. Objetivo: Demostrar la presentación de un abdomen catastrófico posterior a manejo de íleo biliar en un paciente adulto. Caso clínico: Paciente masculino de 43 años que producto de un abdomen agudo obstructivo por íleo biliar evolucionó tórpidamente en otra casa asistencial. Se realizaron 3 intervenciones quirúrgicas, hasta llegar a nuestra casa asistencial donde se le trata de manera multidisciplinaria e integral. Estuvo 120 días hospitalizado y se le realizó 5 intervenciones quirúrgicas para aplicación y recambio de terapia de presión negativa abdominal abierta (ABThera). Durante la última intervención al encontrar una cavidad limpia y sin fugas se realiza gastroentero anastomosis en Y de Roux con una buena evolución clínico-quirúrgica hasta el alta, con seguimiento dos meses posteriores por consulta externa. Conclusiones: El abdomen catastrófico es un reto para el manejo por los cirujanos porque se requiere aparte de un vasto conocimiento también el apoyo de otras especialidades para poder combatir esta entidad(AU)

Introduction: Catastrophic abdomen or hostile abdomen is a surgical entity of great significance due to the loss of the different spaces between organs and the structures of the abdominal cavity. These alterations produce major anatomical changes due to a severe adhesive syndrome. Objective: To show the presentation of a catastrophic abdomen following gallstone ileus management in an adult patient. Clinical case: A 43-year-old male patient who, as a consequence of an acute obstructive abdomen due to gallstone ileus, had a torpid evolution into another care facility. Three surgical interventions were performed before he arrived at our care facility, where he was treated in a multidisciplinary and comprehensive way. He was hospitalized for 120 days and underwent five surgical interventions for application and replacement of the open abdomen negative pressure therapy (ABThera). During the last intervention, upon finding a clean cavity without leaks, a Roux-en-Y gastroenteric anastomosis was performed, with a good clinical-surgical evolution until discharge and follow-up of two months thereafter in the outpatient clinic. Conclusions: Catastrophic abdomen is a challenge to be managed by surgeons because it requires, apart from vast knowledge, the support of other specialties to combat this entity(AU)

Incidencia de factores de riesgo para desarrollo de litiasis vesicular en pacientes menores de 40 años colecistectomizados en el hospital Dr. Ricardo Baquero González. Periodo enero 2019- diciembre 2021. Estudio retrospectivo / Risk factors for the development of vesicular lithiasis in patients under 40 years old cholecystectomy at Hospital Dr. Ricardo Baquero González. Period january 2019-december 2021. Retrospective study

El objetivo de la investigación es analizar la incidencia de los factores de riesgo para el desarrollo de colelitiasis en pacientes menores de 40 años colecistectomizados en el Hospital Ricardo Baquero González. Periodo enero 2019 ­ diciembre 2021.Método: Se realizó un estudio retrospectivo; se analizaron los datos de los de los pacientes diagnosticados e intervenidos por litiasis vesicular. Resultados: Arrojaron que la muestra fue de 151 pacientes; 70% es de sexo femenino y el 30% masculino. El 41% de los pacientes tiene menos de 40 años. En los factores de riesgo se destaca que el 42% son del tipo familiar, el 40% de las mujeres utiliza anticonceptivos orales y el 40% de los pacientes presenta sobrepeso. Conclusión: Se concluye que los casos de litiasis vesicular se encuentran asociados de forma mayoritaria al sexo femenino y a factores de riesgos familiares y al sobrepeso; en cuanto a las mujeres, hubo alta incidencia de casos de litiasis vesicular en aquellas que emplean anticonceptivos orales. Además, en la investigación se observó un aumento en los casos de litiasis vesicular en pacientes que no se encuentran dentro de los grupos de riesgo, como son mujeres menores de 40 años, con peso normal y con pocas gestas(AU)

he objective of the research is to analyze the incidence of risk factors for the development of cholelithiasis in patients under 40 years of age who underwent cholecystectomy at the Ricardo Baquero González Hospital. Period January 2019 - December 2021.Methodi: retrospective study was carried out; Data from patients diagnosed and operated on for gallstones were analyzed. Results: showed that the sample was 151 patients; 70% are female and 30% male. 41% of patients have an age under 40 years old. In the risk factors, it is highlighted that 42% are of the family type, 40% of the women in the sample use oral contraceptives and 40% of the patients are overweight. Concluded: From the investigation it is concluded that the cases of vesicular lithiasis are mostly associated with the female sex and family risk factors and overweight; As for women, there was a high incidence of cases of gallstones in those who use oral contraceptives. In addition, the investigation observed an increase in cases of gallstones in patients who are not within the risk(AU)

Effect of Modified Da Chaihutang on FXR/FGF15/FGFR4 Signaling Pathway in Mice with Cholesterol Gallstone Differentiated into Damp-Heat Syndrome / 中国实验方剂学杂志

ObjectiveTo observe the effect of modified Da Chaihutang on cholesterol gallstone （CS） in mice due to damp-heat based on the farnesoid X receptor （FXR）/fibroblast growth factor 15 （FGF15）/fibroblast growth factor receptor 4 （FGFR4） pathway and explore the molecular biological mechanisms of CS differentiated into damp-heat syndrome from the perspective of correspondence between prescription and syndrome. MethodForty-eight six-week-old mice were randomly divided into the blank group， model group， modified Da Chaihutang （23.4 g·kg-1） group， and ursodeoxycholic acid （0.12 g·kg-1） group， with 12 mice in each group. The ones in the latter three groups were exposed to "internal dampness + external dampness + high-cholesterol diet" for 12 weeks for inducing CS due to damp-heat. Mice in the modified Da Chaihutang group and ursodeoxycholic acid group were gavaged with the corresponding drugs， while those in the model and blank groups with the same amount of normal saline for a total of four weeks. Before and after modeling， mice in each group were subjected to open field tests for determining their activities and mental states. Such general conditions as body mass， food intake， fur， and urine and stool of mice in each group were observed and recorded weekly for judging the damp-heat syndrome. After the intervention， the sampled liver and gallbladder tissues of mice in each group were stained with hematoxylin-eosin （HE） staining， and the serum γ-glutamyltransferase （GGT）， alkaline phosphatase （ALP）， and total bilirubin （TBIL） were determined. The total cholesterol （TC） and total bile acid （TBA） contents in bile were measured by enzyme-linked immunosorbent assay （ELISA）. The mRNA and protein expression levels of FXR， FGF15， FGFR4， and cholesterol 7α-hydroxylase gene （CYP7A1） were assayed by real-time fluorescence quantitative polynucleotide chain reaction （Real-time PCR） and Western blot. ResultCompared with the blank group， the model group exhibited enlarged gallbladder， brown turbid bile with flocculent precipitation visible to the naked eye， obvious damp-heat syndrome， lipoid degeneration in the liver tissue， rough and thickened gallbladder wall， elevated ALP， GGT， and TBIL in serum （P<0.01） and TC in bile （P<0.01）， reduced TBA （P<0.01）， up-regulated FXR， FGF15， and FGFR4 mRNA and protein expression in ileum （P<0.05， P<0.01）， and down-regulated CYP7A1 mRNA and protein expression （P<0.01）. Compared with the model group， the two medication groups displayed improved bile turbidity， and the bile in the modified Da Chaihutang group became clearer. After intervention， the damp-heat syndrome of mice in the modified Da Chaihutang group was significantly alleviated. The liver and gallbladder lesions of mice in the two medication groups were significantly relieved， manifested as reduced serum ALP， GGT， and TBIL （P<0.01）. The reduction in ALP and TBIL of the modified Da Chaihutang group was more significant （P<0.01）. The TC contents in the bile of mice from the two medication groups were significantly lowered， whereas the TBA contents were elevated （P<0.01）， with more significant changes present in the modified Da Chaihutang group （P<0.01）. The mRNA and protein expression levels of FXR， FGF15， and FGFR4 in the modified Da Chaihutang group were down-regulated （P<0.05， P<0.01）， while the mRNA and protein expression levels of CYP7A1 rose （P<0.05）， except that the elevation in FGF15 and FGFR4 protein expression and reduction in CYP7A1 protein expression were not significant. The mRNA and protein expression levels of FXR， FGF15， and FGFR4 in the ursodeoxycholic acid group all decreased， among which the reduction in FXR was remarkable （P<0.05）， and the mRNA and protein expression levels of CYP7A1 were significantly up-regulated （P<0.05）. ConclusionModified Da Chaihutang significantly improves the stone， liver function， bile composition， abnormal cholesterol-bile acid metabolism， and damp-heat syndrome in the model mice of CS differentiated into damp-heat syndrome， which may be related to its regulation of key factors FXR， FGF15， FGFR4， and CYP7A1 mRNA and protein expression in the cholesterol-bile acid metabolism pathway.

Íleo biliar. Una entidad que perdura en el tiempo / Gallstone ileus: A condition that persists over time

RESUMEN Antecedentes: se define como íleo biliar (IB) la obstrucción mecánica del tubo digestivo por la presencia de uno o más litos biliares. La fisiopatogenia responde a una fístula colecistoduodenal. Material y métodos: estudio descriptivo- retrospectivo entre diciembre de 2017 y enero de 2020 que incluyó 5 casos de IB. Se analizaron: sexo, edad, presentación clínica, utilidad de tomografía computarizada (TC), abordaje y conducta quirúrgica, cirujano actuante, localización de obstrucción, tamaño del lito y mortalidad. Resultados: analizamos 5 pacientes con IB y edad promedio de 66 años. En 4 objetivamos abdomen oclusivo y en uno perforativo. En todos los pacientes se realizó tomografía y el abordaje fue la laparotomía. Se optó por enterolitotomía en 4 y resección intestinal en uno. Hubo un deceso. Conclusión: el IB es un cuadro poco frecuente e insospechado, que predomina en mujeres. La tomografía es el estudio de referencia (gold standard). Factores inherentes al paciente y al equipo tratante determinan el abordaje y la conducta quirúrgica.

ABSTRACT Background: Gallstone ileus is defined as a mechanical obstruction due to impaction of one or more gallstones within the gastrointestinal tract. The pathogenesis is due to the presence of a cholecystoduodenal fistula. Material and methods: We conducted a descriptive and retrospective study of five cases of gallbladder ileus between December 2017 and January 2020. Sex, age, clinical presentation, usefulness of computed tomography scan, surgical approach and treatment, surgeon, site of obstruction, gallstone size and mortality were analyzed. Results: A total of five patients were included; mean age was 66 years. Four patients presented bowel obstruction and one patient had bowel perforation. All the patients underwent computed tomography scan and laparotomy. Enterolithotomy was performed in four patients and one patient underwent bowel resection. One patient died. Conclusion: Gallstone ileus is a rare condition more likely to affect women. Computed tomography scan is the gold standard method for the diagnosis. The surgical approach and strategy will depend on patient-related factors and on the experience of the surgical team.

Íleo biliar, una causa poco frecuente de oclusión intestinal / Gallstone Ileus, A Rare Cause of Intestinal Occlusion

RESUMEN Introducción: El íleo biliar representa el 4 por ciento de las causas de obstrucción intestinal en la población general. Objetivo: Mostrar un paciente con cuadro de oclusión intestinal por íleo biliar que fue diagnosticado y tratado en el transoperatorio. Caso clínico: Paciente de 78 años de edad con un cuadro oclusivo por un íleo biliar, al cual se le realizó enterolitotomía como tratamiento definitivo. Conclusiones: El íleo biliar es una causa de oclusión intestinal que todo cirujano general debe tener presente ante un anciano con elementos clínicos e imaginológicos de oclusión y sin intervenciones quirúrgicas previas o hernias de la pared abdominal(AU)

ABSTRACT Introduction: Gallstone ileus represents 4 percent of the causes of intestinal obstruction in the general population. Objective: To present a patient with intestinal obstruction due to gallstone ileus and who was diagnosed and treated during the intraoperative period. Clinical case: The is presented of a 78-year-old patient with an occlusive condition due to gallstone ileus, who underwent enterolithotomy as definitive management procedure. Conclusions: Gallstone ileus is a cause of intestinal occlusion that every general surgeon should be aware of in the presence of an elderly with clinical and imaging elements of occlusion and without previous surgical interventions or hernias of the abdominal wall(AU)