Alterações histológicas da vesícula biliar de doentes submetidos à colecistectomia por colelitíase / Gallbladder histological alterations in patients undergoing cholecystectomy for cholelithiasis

RESUMO Objetivo: descrever os achados histológicos das vesículas biliares de pacientes submetidos à colecistectomia e avaliar a presença de fatores associados ao câncer incidental da vesícula. Métodos: estudo descritivo, transversal e observacional de 1.278 exames anatomopatológicos de vesículas biliares oriundas de colecistectomias por colelitíase e de seus respectivos laudos, realizadas no período de janeiro de 2008 a dezembro de 2017. Resultados: o achado anatomopatológico mais frequente foi a colecistite crônica, presente em 1.251 pacientes (97,8%), seguido pela colesterolose em 131 (10,2%). O câncer de vesícula foi identificado em seis pacientes, com prevalência de 0,5% nesta amostra. Houve associação significativa entre a presença de câncer e idade ≥60 anos e com a espessura da parede ≥0,3cm. Conclusão: houve baixa prevalência de câncer de vesícula na população avaliada, maior ocorrência na população idosa e associação de tumor com espessamento da parede vesicular.

ABSTRACT Objective: to describe the histological findings of the gallbladders of patients undergoing cholecystectomy and to evaluate the presence of factors associated with gallbladder incidental cancer. Methods: we conducted a descriptive, cross-sectional, observational study with 1,278 histopathological exams of gallbladders coming from cholecystectomy for cholelithiasis and of their reports, held from January 2008 to December 2017. Results: the most common pathological finding was chronic cholecystitis, present in 1,251 patients (97.8%), followed by gallbladder cholesterolosis, in 131 (10.2%). Gallbladder cancer was identified in six patients, with a prevalence of 0.5% in this sample. There was a significant association between the presence of cancer and age ≥60 years and wall thickness ≥0.3cm. Conclusion: there was low prevalence of gallbladder cancer in this population, higher occurrence in the elderly and association of the tumor with gallbladder wall thickness.

Cholecystitis due to helminthic infection

Helminthic infections were reported from tropical and subtropical locations in the world. The parasitic helminths develop and migrate to different organs. Unusual cases may afflict the gallbladder and the biliary tract. The parasites invade the bile ducts and cause inflammation, fibrotic lesions, acute and chronic cholecystitis. In this article, we reported three unusual cases of parasitic infection in Kermanshah, Iran. The worms were isolated from gallbladder and biliary tract. The specimens were diagnosed by macroscopic features and staining methods. Ascaris lumbricoides, Taenia saginata and adult type fasciola hepatica isolated from gall bladder and biliary duct. Cholecystectomy was done on all patients suffering from gall bladder inflammation and obstruction

Focal Thickening at the Fundus of the Gallbladder: Computed Tomography Differentiation of Fundal Type Adenomyomatosis and Localized Chronic Cholecystitis

BACKGROUND/AIMS: The objective of our study was to identify useful computed tomography (CT) findings for differentiating fundal type adenomyomatosis from localized chronic cholecystitis involving the fundus of the gallbladder. METHODS: We retrospectively identified cases of 41 patients with pathologically proven adenomyomatosis (n=21) or chronic cholecystitis (n=20) who had fundal thickening of the gallbladder on preoperative abdominal CT. Analysis of the CT findings included evaluation of the thickness, contour, border, intralesional cystic area, adjacent gallbladder wall thickening, presence of inner layer enhancement, enhancement grade, enhancement pattern, and presence of stones. Statistical analyses were performed using the Mann-Whitney U test and Fisher exact test. RESULTS: Oval contour, inner layer enhancement and intralesional cystic area were more frequently noted in adenomyomatosis than in chronic cholecystitis (p<0.05 for each finding). Flat contour and adjacent gallbladder wall thickening were more frequently observed in chronic cholecystitis than in adenomyomatosis. No differences between adenomyomatosis and chronic cholecystitis in terms of the thickness, enhancement grade, enhancement pattern and presence of stones were apparent. CONCLUSIONS: CT may help to differentiate fundal type adenomyomatosis from localized chronic cholecystitis involving the fundus of the gallbladder.

Gallbladder tubrculosis mimicking malignancy: A rare case report.

Summary: Gallbladder tuberculosis is an extremely rare disorder even in endemic region. It often mimics gallbladder malignancy as both of them share some common presentations. This entity is very rarely diagnosed pre-operatively as neither clinical features nor radiology are pathognomonic of gallbladder tuberculosis. The case reported here presented as chronic calculous cholecystitis with mass at gallbladder neck. Patient underwent laparotomy with suspicion of gallbladder carcinoma, which was eventually diagnosed as a case of gallbladder TB following histopathological examination of the resected specimen. He also had pulmonary TB in association and was completely cured with short course antitubercular chemotherapy.

Protocolos de atención de enfermedades quirúrgicas más frecuentes en adultos / Care protocols most common surgical diseases in adults

El Gobierno de Reconciliación y Unidad Nacional a través del Ministerio de Salud, presente el siguiente documento Protocolos de atención de enfermedades quirúrgicas más frecuentes en adultos, que es una recopilación de los servicios de los Hospitales Alemán Nicaraguense y Antonio Lenin Fonseca quienes iniciaron revisión, actualización y elaboración de guías clínicas de las principales patologías atendidas en los servicios. Este trabajo se base en la búsqueda de la unificación de criterios y la mejor utilización de recursos en función de brindar un servicio eficaz y de calidad para nuestros usuarios y usuarias...

Prevalence of Helicobacter spp in chronic cholecystitis and correlation with changes on the histological pattern of the gallbladder / Prevalência do Helicobacter spp na colecistite crônica calculosa e correlação com as alterações histológicas da vesícula biliar

PURPOSE: Establish the prevalence of Helicobacter spp in chronic cholecystitis and its correlation with the gallbladder's histological findings. METHODS: 100 patients were operated for chronic cholecystitis with cholecystolithiasis. In pathological examination of the gallbladder, were evaluated the presence of metaplasia, dysplasia, lymphoid follicles, anaplasia and tumors that might be related to the presence of Helicobacter plus the presence of the bacilli Giemsa by optical microscopy. From the DNA extracted from the gallbladder's bile, PCR was performed by using specific primers for the identification of Helicobacter spp with amplification of the 400bp segment of rRNA gene16S, with positive control DNA from Helicobacter pylori. All the cases negative for isolation of genetic material were excluded. The cases of PCR and Giemsa were used as negative control group. The histological findings were compared to the presence of bacilli and PCR data using a chi-square and Fisher's Exact test (CI = 95.0 percent, p <0.05). RESULTS: Of 68 patients, 42 (61.8 percent) were PCR for Helicobacter spp and 19 (27.9 percent) had Giemsa. There was no correlation between the two findings. The PCR for Helicobacter spp was not correlated to the histological findings. The presence of lymphoid follicles and metaplasia was related to the Giemsa (p = 0.025 and p= 0.039). CONCLUSION: There is high prevalence of Helicobacter spp in patients with chronic cholecystitis and cholecystolithiasis without be correlated with the histological patterns studied.

OBJETIVO: Estabelecer a prevalência do Helicobacter spp nos doentes com colecistopatia crônica calculosa e correlacioná-la com as alterações histológicas da vesícula biliar. MÉTODOS: Foram operados 100 doentes portadores de colecistite crônica calculosa. No anátomo-patológico foram avaliadas a presença de, metaplasias, displasias, folículos linfóides, anaplasias e tumores que pudessem se relacionar à presença do helicobacter e a presença de bacilos Giemsa à microscopia. A partir do DNA extraído da bile foi realizada PCR utilizando-se primers específicos para identificação de Helicobacter spp com amplificação de segmento de 400bp do gene16S rRNA, com controle positivo de DNA de Helicobacter Pylori. Os casos negativos para isolamento de material genético na bile foram excluídos. Os casos de PCR e Giemsa negativos foram utilizados como grupo controle. Os achados histológicos foram comparados ao Giemsa e à PCR utilizando-se Teste do Qui-Quadrado e Exato de Fisher (IC=95,0 por cento; p<0,05). RESULTADOS: De 68 doentes, 42(61,8 por cento) apresentaram PCR para Helicobacter spp e 19(27,9 por cento) Giemsa. Não houve correlação entre os dois achados. Não houve correlação entre alterações histológicas e a PCR (p=0,378). A presença de folículos linfóides e metaplasia estiveram relacionadas ao Giemsa (p=0,025 e 0,039). CONCLUSÃO: Há prevalência elevada de Helicobacter spp nos doentes com colecistite crônica calculosa sem haver correlação com os achados histológicos estudados.

A Case of Cholangiocarcinoma Suspected by Continuous Elevation of CA 19-9 after Surgery of Xanthogranulomatous Cholecystitis / 대한소화기학회지

Xanthogranulomatous cholecystitis (XGC) is an unusual and destructive inflammatory process that is characterized by thickening of the gallbladder (GB) wall with a tendency to adhere to neighboring organs. XGC is often mistaken for GB carcinoma, and the frequency of the coexistence of these two lesions is approximately 10%. Therefore, in case of severe XGC, there is chance of either overlooking the carcinoma or other significant lesions. CA 19-9 is commonly measured in the serum of patients with hepatobiliary malignancies. Although CA 19-9 can be elevated in benign conditions such as cholestasis, pancreatitis, tuberculosis, thyroid disease etc., malignancy should be considered at first in setting of its significant and persistent elevation. We report a case of a 62-year-old man who showed continuously rising level of CA19-9 over 2000 U/mL after cholecystectomy for xanthogranulomatous cholecystitis and finally was diagnosed as cholangiocarcinoma by short-term follow up.

Colecistectomía por Laparoscopia en pacientes asistidos en el Hospital Militar Cap. (Av) Guillermo Hernández Jacobsen Enero 2005-Junio 2007 / Laparoscopic cholecystectomy in patients assisted at the Hospital Militar Cap. (Av) Guillermo Hernández Jacobsen january 2005-june 2007

La laparoscopía es un método importante en la cirugía. Presentamos la experiencia en pacientes con Colecistitis asistidos en nuestro hospital, mediante técnica laparoscópica. Durante enero-2005 a junio-2007 retrospectivamente analizamos hallazgos y tiempo quirúrgico, estancia hospitalaria, complicaciones postoperatorias y tiempo de seguimiento. De 156 pacientes, 140 presentaron litiasis, no en casos restantes. Predominó el sexo femenino. La edad media fue de 39,5 años (rango 19-78). 107 casos debutaron como abdomen agudo, 26 con dolor crónico y 22 de forma casual. La laparoscopia es una técnica válida para manejar La colecistitis. Este abordaje trata la patología de manera reglada.

Intestinal metaplasia in gallbladders: prevalence study / Metaplasia intestinal na vesícula biliar: estudo da prevalência

CONTEXT AND OBJECTIVE: Gallbladder cancer is usually diagnosed at a late stage and generally results in death. Discovery of predisposing factors for this neoplasia could prevent this outcome. In this study, we assess the presence of one of these factors: intestinal metaplasia in gallbladders with stones and inflammatory processes. DESIGN AND SETTING: Cross-sectional study in Hospital do Servidor Público Estadual de São Paulo. METHOD: The first 80 gallbladders from patients who underwent elective cholecystectomy between April and August 2002, presenting stones and chronic inflammation, were studied. The patients were divided into groups according to their age: CC1, from 15 to 40 years; CC2, from 41 to 60 years; and CC3, from 61 to 85 years. RESULTS: Twenty-one patients (26 percent) were male, while 59 (74 percent) were female. In the group CC1, intestinal metaplasia was present in 85.71 percent of the 21 patients studied; in CC2, in 79.41 percent of 34 patients; and in CC3, in 56.00 percent of 25 patients. These differences presented statistical significance (p = 0.04542). CONCLUSION: Intestinal metaplasia is extremely frequent in gallbladders with inflammation and lithiasis, especially in younger patients.

CONTEXTO E OBJETIVO: O câncer da vesicular biliar é diagnosticado tardiamente na maioria das vezes, levando invariavelmente a morte rápida. A detecção de fatores predisponentes ao aparecimento dessa neoplasia pode evitar esse desfecho. Avaliamos, neste estudo, a presença de um desses fatores, a metaplasia intestinal em vesículas biliares com cálculos e inflamação. TIPO DE ESTUDO E LOCAL: Estudo transversal, realizado Hospital do Servidor Público Estadual de São Paulo. MÉTODOS: Foram estudadas as primeiras 80 vesículas biliares de pacientes submetidos a colecistectomias eletivas entre abril e outubro de 2002, que apresentavam cálculos e inflamações crônicas. Os pacientes foram divididos em grupos segundo a faixa etária: CC1 de 15 a 40 anos, CC2 de 41 a 60 anos e CC3 de 61 a 85 anos. RESULTADOS: 21 pacientes (26 por cento) eram do sexo masculino, enquanto 59 (74 por cento) do sexo feminino. No grupo CC1, foram estudados 21 pacientes e encontrou-se metaplasia intestinal em 85,17 por cento. Já no grupo CC2 a presença de metaplasia intestinal foi de 79,41 por cento em 34 pacientes, e no grupo CC3, de 56,00 por cento em 25 pacientes avaliados. As diferenças tiveram significância estatística (p = 0,04542). CONCLUSÃO: A prevalência de metaplasia intestinal é extremamente alta em vesículas biliares com colecistite crônica e litíase, particularmente em pacientes jovens.

Mucocele apendicular y colecistitis aguda gangrenada / Appendiceal mucocele and gangrenous cholecystitis

Objetivo: descripción de un caso de mucocele apendicular y colecistitis aguda gangrenada, atendido en el Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS. Caso clínico: hombre de 80 años de edad que ingresó al hospital con diagnóstico de colecistitis aguda y tumor abdominal de etiología desconocida, dolor abdominal de 10 días de evolución localizado en hipocondrio derecho, sin fiebre ni pérdida importante de peso. Los exámenes de laboratorio mostraron únicamente leucocitosis moderada. La tomografía computarizada abdominal mostró vesícula biliar con paredes engrosadas y datos de agudización, así como tumor abdominal en fosa iliaca derecha. Se exploró quirúrgicamente con los siguientes hallazgos: colecistitis aguda supurada y tumoración apendicular de 20 cm de longitud, sin datos de malignidad. Se realizó colecistectomía y apendicectomía. El periodo posoperatorio transcurrió sin incidentes. El diagnóstico histopatológico fue de mucocele apendicular no roto. El paciente fue dado de alta a los cinco días. Pasados cinco meses de la intervención, se encontraba asintomático.

OBJECTIVE: We present a case report of appendiceal mucocele and gangrenous cholecystitis. SETTING: Hospital de Especialidades, Centro Médico Nacional Siglo XXI, México, D.F. CLINICAL CASE: An 80-year-old man was admitted to the hospital with diagnosis of acute cholecystitis and abdominal tumor under study, with complaints of abdominal pain for 10 days located in the right upper quadrant, without fever or significant weight loss. Laboratory analyses revealed moderate leucocytosis. CT of the abdomen revealed thickening of the gallbladder wall and acute local inflammation, as well as the presence of abdominal tumor in the right lower quadrant. The patient was surgically explored with the following findings: gangrenous cholecystitis and appendiceal tumor of 20 cm length. Cholecystectomy and appendectomy was performed. The postoperative period was normal. The final histological report was appendiceal mucocele and the patient was discharged after 5 days. The patient is currently without complaints at 5 months postoperatively.

Study of nucleolar organizer regions (NORs) in lesions of gallbladder.

Tissue sections from 100 specimens of gallbladder including 40 cases of chronic cholecystitis, 30 cases of epithelial hyperplasia and 30 cases of well, moderately and poorly differentiated adenocarcinoma of gallbladder were studied for argyrophillic nucleolar organizer regions (AgNORs). The arithmetic mean +/- S.D. were calculated for each category. This showed NOR counts of chronic cholecystitis--(1.89+/-0.96), epithelial hyperplasia--(3.99+/-1.03), well differentiated adenocarcinoma (WDCA)--(7.04+/-1.34), moderately differentiated adenocarcinoma (MDCA)--(7.52+/-0.97) and poorly differentiated adenocarcinoma (PDCA)--(8.37+/-1.27). The study revealed increasing number of AgNORS from cases of chronic cholecystitis to epithelial hyperplasia to carcinoma gallbladder, but a considerable overlap in AgNOR counts of individual cases was observed suggesting that though AgNOR count cannot act as a specific diagnostic parameter for diagnosis of early carcinoma & dysplasia in isolated cases, they may prove to be a good adjunct to presently available imaging techniques and cytology.

A case of xanthogranulomatous cholecystitis

Xanthogranulomatous cholecystitis (XGC) is an uncommon, focal or diffuse destructive inflammatory disease of the gallbladder that is assumed to be a variant of conventional chronic cholecystitis. A 36-year-old male was admitted to Chonnam National University Hospital with a 10-day history of right upper quadrant pain with fever. 15 years ago, he was first diagnosed as having hemophilia A, and has been followed up in the department of Hematology. Computed tomogram (CT) revealed a well-marginated, uniform, marked wall thickening of the gallbladder with multiseptate enhancement. Magnetic resonance imaging (MRI) demonstrated diffuse wall thickening of the gallbladder by viewing high signal foci with signal void lesions. After factor VIII replacement, exploration was done. On operation, the gallbladder wall was thickened and the serosa were surrounded by dense fibrous adhesions which were often extensive and attached to the adjacent hepatic parenchyma. There was a small-sized abscess in the gallbladder wall near the cystic duct. Dissection between the gallbladder serosa and hepatic parenchyma was difficult. Cross sections through the wall revealed multiple yellow-colored, nodule-like lesions ranging from 0.5-2 cm. There were also multiple black pigmented gallstones ranging from 0.5-1 cm. The pathologic findings showed the collection of foamy histiocytes containing abundant lipid in the cytoplasm and admixed lymphoid cells. Histologically, it was confirmed as XGC. We report a case with XGC mimicking gallbladder cancer in a hemophilia patient.

Neoplasias y displasias de vesícula biliar y su relación con litiasis. Estudio clinicopatológico de casos y controles / Neoplasm and dysplasia of the gallbladder and their relation with lithiasis. A case-control clinical-pathological study

Antecedentes. la litiasis es uno de los mayores factores de riesgo para cambios inflamatorios, metaplásicos, displásicos y neoplásicos de vesícula biliar, con frecuencia variable en diferenes poblaciones. Objetivo. determinar la frecuencia de asociación de los principales procesos patológicos y datos clínicos con litiasis vesicular. Material y métodos. estudio transveral, descriptivo de 1,367 piezas de colecistectomía, con (1,096) y sin (271) litiasis fue la siguiente: metaplasia psudopilórica 50 por ciento y 25 por ciento; metaplasia intestinal 16 por ciento y 2 por ciento; displasia de bajo grado 40 por ciento y 17 por ciento; displasia de alto grado 16 por ciento y 2 por ciento; carcinoma in situ 1.5 por ciento y 0 por ciento y carcinoma invasor 2.6 por ciento y 0 por ciento. El 80 por ciento de los casos con litiasis, el 65 por ciento de los casos de carcinoma in situ y el 90 por ciento de los casos de carcinoma invasor correspondieron a mujeres. La edad media de los pacientes con displasia de bajo y alto grado, carcinoma in situ y carcinoma invasor fue de 42, 48, 53 y 61 años, en ese orden. Conclusiones. la frecuencia de procesos inflamatorios agudos, colecititis crónica xantogranulomatosa, adenomiomatosis, metaplasia pseudopilórica e intestinal, pólipos hiperplásicos, displasia de bajo y alto grado, adenomas tubulares, carcinoma in situ y carcinoma invasor fue mayor en vesículas con litiasis que en vesículas sin litiasis (p<.05)

Colecistectomía laparoscópica en colecistitis aguda / Laparoscopic cholecystectomy in acute cholecystitis

Objetivo: Estudio clínico retrospectivo de pacientes intervenidos por colecistitis mediante laparoscopia. Material y métodos: Sobre 1171 pacientes con litiasis biliar operados, se seleccionaron 269 (23 por ciento). Se clasificaron en: edematosa, gangrenosa, empiema, hidropesía y crónica reagudizada. Resultados: Predominó el sexo femenino, (61,3 por ciento), aunque en la forma gangrenosa fue el masculino (p = 0,001). La edematosa fue la más frecuente (52,4 por ciento). La empiemática tuvo el mayor índice de conversión (31,4 por ciento) (p < 0,001). No hubo diferencias respecto de los períodos (p = 0,550); y sexo (p = 0,450). La litiasis coledociana (5,2 por ciento) no tuvo relación con las formas anatomopatológicas (p = 0,09). El 71,4 por ciento fue resuelta antes, durante o después de la cirugía; el 28,6 por ciento se convirtió. Se complicaron 7 enfermos (2,6 por ciento): hemoperitoneo, 2 (0,7 por ciento); bilirragia 2 (0,7 por ciento); lesi162n de la vía biliar, uno (0,4 por ciento); absceso subfrénico, uno (0,4 por ciento) y perforación colónica, uno (0,4 por ciento). No hubo relación con las formas anatomopatológicas, (p =0,343). Se reoperaron 3 enfermos (1,1 por ciento); 2 por hemorragia y uno por perforación colónica, la lesión quirúrgica fue convertida. El absceso subfrénico se drenó por punción. Falleció un enfermo (0,3 por ciento). Conclusiones: La colecistectomía laparoscópica en la colecistitis es una intervención que otorga todas las ventajas del procedimiento, con resultados similares a la cirugía convencional. El índice de conversiones es alto, y se halla relacionado directamente con la forma anatomopatológica, que provoca los fenómenos locales que imposibilitan la colecistectomía

Litíase biliar em pacientes jovens: análise de 100 casos / Biliary lithiasis on young patients: analysis of 100 cases

Os autores apresentam um estudo retrospectivo de 100 pacientes submetidos à colecistectomia por litíase biliar com idade entre 12 e 30 anos no Hospital das Forças Armadas-DF no períodp de 1990 a 1995. Desses 100 pacientes, 47 (47,0 por cento) pacientes foram tratados por colecistectomia videolaparoscópica e 53 (53,0 por cento) por colecistectomia convencional. A prevalência da litíase biliar nesta faixa etária foi de 15,6 por cento (100/641) com predomínio do sexo feminino-88 (88 por cento). As manifestaçöes clínicas mais freqüentes foram a cólica biliar, as náuseas e vômitos. Um total de 89 (89,0 por cento) pacientes apresentavam colecistite crônica e 11 (11,0 por cento) colecistite aguda. A prevalência de coledocolitíase foi de 4,0 por cento. As complicaçöes pós-operatórias ocorreram em dois (2,0 por cento) casos e a mortalidade foi nula. O tempo de permanência hospitalar e as queixas pós-operatórias foram menores nos pacientes submetidos à colecistectomia videolaparoscópica, fazendo com que essa técnica seja uma boa opçäo no tratamento da colelitíase em jovens.

Role of AgNORs in diagnosis of early malignant lesions of gall bladder.

Sections from eighty nine specimens of gall bladder including 40 cases of chronic cholecystitis, 9 dysplasia 15 well differentiated adenocarcinoma, 14 moderately differentiated adenocarcinoma and 11 poorly differentiated adenocarcinomas were studied for argyrophilic nucleolar organizer regions (AgNOR's). The difference between mean +/- SD NOR counts of chronic cholecystitis (1.97 +/- 0.28), dysplasia (5.6 +/- 0.88) well differentiated adenocarcinoma (7.2 +/- 0.30) and moderately differentiated adenocarcinoma (8.0 +/- 0.63) was statistically significant (p < 0.001). NOR counts of poorly differentiated adenocarcinoma (8.5 +/- 0.78) were higher than moderately differentiated carcinoma but the difference was not statistically significant. Despite the significant difference in the mean values, a considerable overlap in the NOR counts of individual cases of different groups was observed suggesting that though NOR counts can not act as a specific diagnostic parameter for diagnosis of early carcinoma and dysplasia in isolated cases, they may prove to be a good adjunct to already existing parameters like imaging techniques or cytology.

Bilicultivo de germenes aeróbios y sensibilidad antimicrobiana por función intraoperatoria en colecistitis aguda y colelitiasis en el H.R.H.D., mayo a julio 1995

Se realizó un estudio retrospectivo en 50 pacientes, 36 del sexo femenino y 14 masculino, que ingresaron al servicio de cirugía del HRHD, presentando cuadros de colecistitis aguda (52 por ciento) y de colelitiasis (48 por ciento), a quienes se les realizó biblicultivo por punción intraoperatoria. Encontrándose mayor incidencia en ambas patologías entre la 3 a 4 década de la vida. Se obtuvo un 52 por ciento de cultivos positivos y un 48 por ciento de cultivos negativos. Hubo mayor frecuencia de positividad entre los pacientes con colecistitis aguda (57.69 por ciento) y de colelitiasis (45.83 por ciento). Los gérmenes más frecuentes fueron E. coli (24 por ciento) y salmonella (16 por ciento), siendo más frecuente E. coli en colecistitis aguda (30.76 por ciento) y en colelitiasis con (20.83 por ciento) salmonella. Entre los fármacos con mayor sensibilidad destaca Lomefloxacina con 96.15 por ciento y cloramfenicol 88.46 por ciento, siendo E. coli y salmonella sensibles en un 100 por ciento a estos dos fármacos