Hidrops vesicular secundario a vólvulo: reporte de un caso / Gallbladder hydrops due to vesicular volvulus: a case report

Resumen Introducción: El vólvulo de vesícula biliar (VVB) es una causa extremadamente rara de colecistitis aguda. Aproximadamente 500 casos han sido reportados en la literatura mundial. Puede generar una obstrucción total del drenaje vesicular e isquemia con alto riesgo de progresar a perforación y peritonitis biliar. Caso clínico: Mujer de 90 años consultó por dolor hipogástrico de inicio súbito, asociado a masa abdominal palpable y dolorosa en flanco y fosa ilíaca derecha. Tomografía axial computada de abdomen y pelvis demostró una acentuada distensión de la vesícula biliar, ubicada por fuera de la fosa vesicular y con un punto sugerente de torsión. Fue sometida a laparotomía exploradora, desvolvulación seguida de colecistectomía, con evolución posoperatoria favorable. Discusión: Para el desarrollo de un VVB se requiere una "vesícula flotante", su cuadro clínico es inespecífico y muchas veces es confundido con una colecistitis aguda litiásica, su diagnóstico preoperatorio es difícil pese al estudio con imágenes. La intervención quirúrgica oportuna es el único tratamiento resolutivo, con excelentes resultados. Conclusión: La VVB es una patología rara, representa un desafío diagnóstico tanto para cirujanos como radiólogos.

Introduction: Gallbladder volvulus (GV) is an extremely rare cause of acute cholecystitis. Approximately 500 cases have been reported in world literature. It can lead to total obstruction of the gallbladder drainage and ischemia with a high risk of progressing to perforation and biliary peritonitis. Case report: 90-year-old woman consulted due to hypogastric pain of sudden onset, associated with painful palpable abdominal mass in the flank and right iliac fossa. Computed axial tomography of the abdomen and pelvis demonstrated an accentuated distention of the gallbladder, located outside the gallbladder fossa and with a point suggestive of torsion. She underwent exploratory laparotomy, devulvulation followed by cholecystectomy, with favorable postoperative evolution. Discussion: The development of GV requires a "floating gallbladder", its clinical picture is non-specific and is often confused with acute lithiasic cholecystitis. Its preoperative diagnosis is difficult despite the imaging study. Timely surgical intervention is the only resolutive treatment, with excellent results. Conclusion: GV is a rare pathology, it represents a diagnostic challenge for both surgeons and radiologists.

Vesícula en porcelana: un interesante hallazgo incidental. Presentación de un caso y revisión de la literatura / Porcelain gallbladder an interesting incidental finding. Case report and literature review / Vesícula em porcelana: um achado incidental interessante. Apresentação de caso e revisão de literatura

RESUMEN Se realizó la comunicación de un caso recientemente diagnosticado en el Hospital Docente Clínico Quirúrgico "Joaquín Albarrán" de La Habana. El caso que se presenta correspondió con un paciente masculino de 73 años de edad que en el estudio autópsico se reveló la presencia de vesícula en porcelana, la cual, según la literatura, su identificación es un diagnóstico incidental durante el estudio del paciente por otro padecimiento, en su mayoría neoplásico o en la autopsia. Su relación con el cáncer de vesícula presenta controversias. La vesícula en porcelana es una entidad caracterizada por la calcificación intramural de la vesícula, tiene una incidencia reportada de 0,06 a 0,8 % de las colecistectomías realizadas. Se realizó revisión de la literatura en bases de datos, MEDLINE, PubMed, ELSEVIER y SciELO, con un total de 26 publicaciones encontradas entre 1999 y 2018.

ABSTRACT The communication of a newly diagnosed case was carried out at the "Joaquín Albarrán" Surgical Clinical Teaching Hospital in Havana. The case presented corresponded with a 73-year-old male patient who in the autopsy study revealed the presence of a porcelain gallbladder, which, according to the literature, its identification is an incidental diagnosis during the study of the patient for another condition, mostly neoplastic or at autopsy. His relationship with gallbladder cancer is controversial. The porcelain gallbladder is an entity characterized by intramural gallbladder calcification, has a reported incidence of 0.06 to 0.8% of the cholecystectomies performed. We reviewed the literature in databases, MEDLINE, PubMed, ELSEVIER and SciELO, with a total of 26 publications found between 1999 and 2018.

RESUMO A comunicação de um caso recentemente diagnosticado foi realizada no Hospital de Ensino Clínico Cirúrgico "Joaquín Albarrán", em Havana. O caso apresentado correspondeu a um paciente do sexo masculino, 73 anos, que no estudo de autópsia revelou a presença de uma vesícula na porcelana, a qual, segundo a literatura, sua identificação é um diagnóstico incidental durante o estudo do paciente para outra condição, principalmente neoplásico ou na autópsia. Sua relação com o câncer de vesícula biliar é controversa. A vesícula biliar de porcelana é uma entidade caracterizada pela calcificação intramural da vesícula biliar, com incidência relatada de 0,06 a 0,8% das colecistectomias realizadas. Revisamos a literatura nas bases de dados MEDLINE, PubMed, ELSEVIER e SciELO, com um total de 26 publicações encontradas entre 1999 e 2018.

Vólvulo de la vesícula biliar como causa de abdomen agudo: reporte de caso y revisión de la literatura / Gallbladder volvulus as a cause of acute abdomen: case report and literature review

Resumen Antecedentes: El vólvulo de la vesícula biliar se produce por el giro de la vesícula sobre su mesenterio a lo largo del eje del conducto y arteria císticos, con afectación de la irrigación vascular de forma completa o incompleta, pudiendo existir ciertas características anatómicas predisponentes. Caso clínico: Masculino de 87 años quien cursó con abdomen agudo; sospechando cuadro de piocolecisto, se realizó exploración quirúrgica encontrando como hallazgos triple torsión vesicular y múltiples litos color oscuro; se realizó colecistectomia abierta, cursando con una evolución satisfactoria. Discusión: Se trata de una entidad infrecuente que puede simular una colecistitis aguda; generalmente tiene buen pronóstico cuando el diagnóstico se realiza a tiempo. El tratamiento de elección es la colecistectomía laparoscópica.

Abstract Background: The gallbladder volvulus is produced by the rotation of the gallbladder over its mesentery along the axis of the cystic duct and artery, with involvement of vascular irrigation in a complete or incomplete way, and there may be certain predisposing anatomical characteristics. Clinical case: Male patient of 87 years who attended with acute abdomen, suspecting pyogenic cholecystitis, performs surgical exploration finding as vesicular triple twist, multiple stones dark. Open cholecystectomy is performed, following a satisfactory evolution. Discussion: It is an uncommon entity that can simulate acute cholecystitis, usually has a good prognosis, when the diagnosis is made on time. The treatment of choice is laparoscopic cholecystectomy.

Hallazgos clínicos e histopatológicos en pacientes con adenomiomatosis vesicular / Clinical and histopathological findings in patients with gallblader adenomyomatosis

Objetivo: El objetivo del estudio es describir la presentación clínica e histopatológica de la adenomiomatosis vesicular en una serie de pacientes colecistectomizados. Material y método: Entre el 1 de enero del 2010 y el 30 abril del 2015 se realizaron 6.957 colecistectomías, diagnosticándose adenomiomatosis en 95 de las vesículas extirpadas (1,4%). Se describen los hallazgos clínicos e histopatológicos en estos pacientes. Resultados: En 53 pacientes (55,8%) se presentó dolor abdominal. Alteraciones histológicas concomitantes se presentaron en la mucosa vesicular de 34 pacientes (35,8%), siendo la metaplasia pilórica la más frecuente (21%); y en 8 pacientes (8,4%) se presentó displasia de alto y bajo grado. Las patologías asociadas más frecuentes fueron colelitiasis 82,1% y colecistitis crónica 85,3%. Conclusiones: En la serie estudiada se observaron diversas alteraciones histológicas, incluyendo la displasia de alto grado. La colelitiasis se presentó con una frecuencia elevada.

Aim: The aim of the study was to describe the clinical and histopathologic presentation of adenomyomatosis (ADM) of the gallbladder in a series of patients. Material and method: Between January 1, 2010 to April 30, 2015, 6957 patients underwent cholecystectomy. Among them, ADM was diagnosed in 95 of cholecystectomy specimens (1.4%). Clinical and pathological findings in these patients are described. Results: In 53 patients (55.8%) presented abdominal pain. Concomitant histological changes occurred in the gallbladder mucosa of 34 patients (35.8%), being the most frequent pyloric metaplasia (21%); and in 8 patients (8.4%) high-grade dysplasia and low-grade dysplasia was presented. The most frequent associated pathologies were cholelithiasis in 82.1%, and chronic cholecystitis in 85.3%. Conclusions: In this serie, various histological changes were observed, including high-grade dysplasia. Cholelithiasis was presented with high frequency.

A Case of Ciliated Foregut Cyst of the Gallbladder / 대한소화기학회지

Congenital cysts of the gallbladder are extremely rare, hence only a few ciliated foregut cysts of gallbladder have been reported. We report a case of a 20-year-old woman presenting with mild right upper quadrant abdominal discomfort, with normal levels of serum bilirubin and liver function tests. Abdominal ultrasonography revealed a well-defined cystic mass measured about 2 cm attached to the neck of gallbladder, with internal echogenic debris suggesting a complicated cyst, such as a hemorrhagic cyst. Abdominal computed tomography and magnetic resonance cholangiopancreatography revealed similar findings. Laparoscopic cholecystectomy showed a slightly distended gallbladder. The size of cyst on the neck was 1.6x1.2 cm, and it contained mucosa lined by ciliated pseudostratified columnar epithelium and underlying smooth muscle layers. Histopathology identified a ciliated foregut cyst of gallbladder.

The Risk of Colorectal Neoplasia in Patients with Gallbladder Diseases

Cholecystectomy is associated with an increased risk of colorectal cancer, but little is known about the relationship between gallbladder disease and colorectal adenoma. Gallbladder polyps and colorectal neoplasia (CRN) share several risk factors such as obesity, diabetes and metabolic syndrome, which might account for their association. In this study, we investigated whether asymptomatic patients with gallbladder disease are at increased risk of CRN and identified the factors to their association. The study population consisted of 4,626 consecutive, asymptomatic individuals drawn from a prospective health check-up cohort who underwent both ultrasonography and colonoscopy screening. The prevalence of CRNs in patients with gallbladder polyps or gallstones was significantly higher than that in the control group (32.1% vs. 26.8%; P = 0.032, 35.8% vs. 26.9%; P = 0.020). A multivariate regression analysis showed that gallbladder polyps were an independent risk factor for CRN [adjusted odds ratio (OR): 1.29; 95% confidence interval (CI); 1.03-1.62] whereas gallstones were not (adjusted OR: 1.14; 95% CI: 0.79-1.63). The adjusted OR for the risk of CRN was 1.12 for gallbladder polyps or = 5 mm (95% CI, 1.15-2.77). The prevalence of CRN increased with increasing polyp size (P trend = 0.022). Our results suggest that colorectal neoplasia is significantly related to gallbladder polyps, especially those > or = 5 mm.

Is the Prevalence of Gallbladder Polyp Different between Vegetarians and General Population? / 대한소화기학회지

BACKGROUND/AIMS: Gallbladder polyps (GBP) are a common clinical finding that can express malignant potential. The aim of this study was to evaluate whether vegetarianism protects against GBP, together with other putative risk factors. METHODS: A retrospective, cross-sectional study was conducted with subjects who received a health check-up from July 2005 to December 2011. Korean Buddhist priests, who are obligatory vegetarians by religious belief, were identified as vegetarians (vegetarian group) and compared with a non-vegetarian control group sampled from those coming for health check-ups at the same institution. RESULTS: Out of 18,483 subjects, GBP were found in 810 (4.4%). Although GBP tended to be less common in the vegetarian group (23 [3.5%] out of 666) than in control group (787 [4.4%] out of 17,817), the difference was insignificant statistically (p=0.233). By logistic regression, old age (OR=1.61, 95% CI=1.19-2.26 for 30-39 years; OR=1.47, 95% CI=1.08-1.98 for 40-49 years), male gender (OR=1.51, 95% CI=1.31-1.75), high BMI (OR=1.18, 95% CI=1.00-1.39 for > or =23.0 kg/m2 and <25.0 kg/m2) and HBsAg positivity (OR=1.53, 95% CI=1.19-1.98) were independent risk factors of GBP. CONCLUSIONS: GBP was significantly associated with old age, male gender, high BMI and HBsAg positivity, but not with vegetarianism.

Monosegmental Hepatobiliary Fibropolycystic Disease Mimicking a Mass: Report of Three Cases

Hepatobiliary fibropolycystic diseases are a unique group of entities involving the liver and biliary tract, which are caused by abnormal embryologic development of the ductal plates at various stages. We experienced strange hepatobiliary fibropolycystic diseases with a complex mass composed of malformed ducts and biliary cysts, which did not belong to, and were different from, previously known malformations. They were unique in imaging and histologic features. We herein report three cases of monosegmental hepatobiliary fibropolycystic disease mimicking a mass.

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.

Ascariasis vesicular: reporte de un caso / Gallbladder ascariasis: case report

We report a case of a young patient who was admitted for study and management of severe hypocalcemia. During evolution of the condition the patient presents abdominal pain (biliary colic) related to the presence of Ascaris lumbricoides in the gallbladder, responding to conservative medical therapy.

Reportamos un caso de un paciente joven que ingresó para estudio y manejo de una hipocalcemia grave. Durante su evolución el paciente presentó dolor abdominal (cólico vesicular) relacionado con la presencia de un ejemplar de Ascaris lumbricoides en la vesícula biliar, que respondió a terapia médica conservadora.

Association between Metabolic Syndrome and Gallbladder Polyps in Healthy Korean Adults

The goal of this study was to evaluate the association between gallbladder (GB) polyps and metabolic syndrome. A total of 5,685 healthy subjects were included, and 485 of these subjects had GB polyps and 744 had metabolic syndrome. In this study, metabolic syndrome was diagnosed according to standards suggested by the AHA/NHLBI ATP III 2005, and abdominal obesity (> or = 90 cm in men and > or = 85 cm in women for Korean) was diagnosed according to standards set forth by the Korean Society for Study of Obesity. Biphasic logistic regression adjusted for age and gender was used to evaluate the association between metabolic syndrome and GB polyps. Subjects who were male (OR, 1.493; 95% CI, 1.11-2.00) and hepatitis B suface Ag (HBsAg) positive (OR, 1.591; 95% CI, 1.06-2.38) were significantly more likely to have GB polyps. The metabolic syndrome group had a higher risk of GB polyps (OR, 1.315; 95% CI, 1.01-1.69) than the group without metabolic syndrome. In conclusion, subjects who were HBsAg positive and male appear to be associated with the risk of GB polyps. The presence of metabolic syndrome also appears to be associated with the risk of GB polyps in Koreans.

Divertículo verdadero de vesícula biliar / True diverticulum of the gallbladder

Paciente sexo masculino de 58 años de edad que concurre con motivo de la realización de un control clínico. El estudio ecográfico revela la existencia de una imagen de tipo diverticular localizada a nivel de la cara hepática del bacinete vesicular no refiriendo síntomas relacionados con el árbol biliar.

Características alimentarias asociadas a sintomatología biliar y el manejo sugerido de la misma en pobladores de dla comunidad de Ucureña, en el segundo semestre de 2009 / Food characteristics associated with biliary symptoms and suggested handling the same in people living Ucureña community, in the second half of 2009

Las características alimentarias de los pobladores pueden favorecer la formación de los cálculos biliares y éstos condicionar a sintomatología biliar importante, especialmente si el consumo es alto en grasas. Como objetivo de investigación se planteó, el conocer la sintomatología biliar en la población de Ucureña, así como identificar las características alimentarias y el tratamiento natural aplicado. Bajo una metodología cuantitativa, transversal, descriptiva y exploratoria, aplicada mediante entrevista y recordatorio de dieta de 24 horas en la población de Ucureña, se evidenció que la sintomatología biliar más frecuente es el dolor y cólico biliar acompañado de náuseas y vómitos, el 8% de la población entrevistada fue diagnosticada por un médico, pero, no cumple con el tratamiento. La alimentación de la población estudiada está basada en un alto consumo de hidratos de carbono, el 62% de la población sobrepasa el 55% de calorías a partir de hidratos de carbono recomendado. El aporte calórico diario a partir de las grasas es bajo menos del 30% casi en el total de la población; pero, la alimentación por raciones muestra un consumo de carne de cerdo del 88% de la población con una frecuencia de una a tres veces por semana.El tratamiento natural más recomendado por los pobladores es el mate de rompe piedra, manzanilla y paico.

Fasciola Hepatica worm swims in the gallbladder

Human infestation with liver flukes is rare, as they are accidental host by ingestion of contaminated water and vegetables. To document the presence of this disease in Iraq/ Kurdistan region, we are reporting this case of Fasciola Hepatica infestation to a young lady with recurrent attacks of Rt. Abdominal pain. The worm was found, during cholecystectomy, swimming in the bile of gallbladder

Review of cholecystectomy for non hemolytic gallstone in single pediatric surgery unit

In the last years following the extensive use of ultrasound scanning an increasing number of children with cholelithiasis has been identified. Prevalence of cholelithiasis has been well reported, and frequency of cholecystectomy had been addressed by some investigators. The aim of our retrospective study was to evaluate the management of children with cholelithiasis observed at the Pediatric and Surgical unit linked to the Maternity and Child Teaching Hospital. The records of all patients below age of 14 years, undergoing cholecystectomy for cholelithiasis, at Maternity and Child Teaching Hospital in Al- Qadisiya governorate in Iraq, from January 2005 to December 2008 were reviewed. A total of 13 pediatric patients were included in this study. Participants had a mean age of 5.6 years [SD, 2.9 years; range, 2.5-13]. There were 9 female and 4 male patients. Diagnosis of cholelithiasis was performed in all patients by ultrasound exam. All patients underwent cholecystectomy and extensive evaluations for their abdominal pain. The cause for gallbladder disease was identified as personal and familial anamnesis in 4 patients [30.7%]. Intra- and post-surgery course was adequate in all patients, but 2 who had transient complications. In our experience, approach to patients with gallbladder stones was heterogeneous suggesting the need for a common protocol. However, our data show that etiology, sex incidence, diagnosis's modality and management of pediatric patients with gallbladder stones is comparable to previous reported casistics. Pediatricians and pediatric surgeons have to consider that cholelithiasis can occur in children. Common diagnostic, therapeutic and follow-up protocols are needed to improve our knowledge on this pediatric disease

A Case of Actinomycosis of Gallbladder Presenting as Acute Cholecystitis / 대한소화기학회지

Actinomycosis is a chronic suppurative and granulomatous disease, characterized by the formation of abscess, draining sinuses, abundant granulation, and dense fibrous tissue. Actinomycosis of the gallbladder is extremely rare. We report a case of an 56-years old man who abruptly presented with right upper quadrant abdominal pain. Abdominal CT showed that the gallbladder had 2 cm sized stone and an edematous thick wall. Our preoperative diagnosis was acute calculous cholecystitis. After the management of acute cholecystitis, laparoscopic cholecystectomy was performed but converted to open surgery due to severe adhesion to liver and greater omentum. Partial cholecystectomy was performed. Histologic section of the gallbladder showed sulfur granule with gram-positive branching bacilli compatible with actinomyces. After cholecystectomy, the patient received intravenous penicillin G for 2 weeks, followed by oral penicillin for 3 months.

Litiasis coledociana / Choledocal lithiasis

Se presenta un caso en el que luego de realizar un estudio ecográfico abdominal se diagnosticó litiasis coledociana a un paciente que presentaba antecedentes de litiasis vesicular, dolor en flanco derecho, e ictericia. También se describen algunas características de la enfermedad.

Poliposis vesicular múltiple / Multiple polyposis of the gallbladder

A partir de un caso en el que se diagnosticó poliposis vesicular múltiple luego de realizar una ecografía hepatobiliar de control, se describen sus principales características y los aspectos a tener en cuenta al realizar estudios ecográficos.

Costes: colecistectomía laparoscópica frente a colecistectomía convencional / Costs: laparoscopic cholecystectomy versus conventional cholecystectomy

Se realizó un estudio de intervención cuasiexperimental, del tipo de las investigaciones en sistemas y servicios de salud, que evalúa los resultados de la cirugía de mínimo acceso en comparación con la cirugía convencional utilizada en pacientes con enfermedades de la vesícula biliar que requerían tratamiento quirúrgico y que fueron operados en el Hospital General Universitario Abel Santamaría Cuadrado, en Pinar del Río, entre el 1.ro de enero de 2002 y el 31 de diciembre de 2004. El grupo de estudio estuvo constituido por 1 335 pacientes operados por vía laparoscópica, mientras que el grupo control integró a los operados por el método quirúrgico convencional. Se evalúo además la relación costes-beneficios. Los datos obtenidos se incluyeron en una base de datos para el procesamiento estadístico, que se realizó mediante estadística descriptiva y aplicando la frecuencia porcentual y la frecuencia absoluta. Con la colecistectomía laparoscópica se observó una reducción significativa de la estadía hospitalaria posoperatoria y obviamente, de los costes por internación. El beneficio económico debido al egreso hospitalario precoz resultó en 389 663,10 CU(AU)

He/she was carried out a study of intervention cuasiexperimental, of the type of the investigations in systems and services of health that it evaluates the results of the surgery of minimum access in comparison with the conventional surgery used in patient with illnesses of the vesicle biliar that required surgical treatment and that they were operated in the University General Hospital Abel Squared Santamaría, in Pinegrove of the River, between January 1.ro 2002 and December 31 2004. The study group was constituted by 1 335 patients operated for via laparoscópica, while the group control integrated those operated by the conventional surgical method. You also evaluates the relationship cost-benefits. The obtained data were included in a database for the statistical prosecution that was carried out by means of descriptive statistic and applying the percentage frequency and the absolute frequency. With the colecistectomía laparoscópica a significant reduction of the demurrage hospital posoperatoria was observed and obviously, of the costs for internment. The economic benefit due to the precocious hospital expenditure was in 389 663,10 CU(AU)