Síndrome de Klipper-Trenaunay-Weber con compromiso vesical y uterino tratado por vía endoscópica y endovascular / Klippel-Trenaunay-Weber syndrome with vesical and uterine involvement treated by endoscopic and endovascular routes

El síndrome de Klippel-Trenaunay-Weber (SKTW) es una rara malformación venosa que, en general afecta a los miembros inferiores y, más raramente, a los superiores. Se caracteriza por formaciones angiomatosas cutáneas, várices e hipertrofia del miembro afectado. El compromiso genitourinario es sumamente infrecuente. Se presenta el caso de una paciente de 14 años. Ingresó por hematuria macroscópica de 48 h de evolución y metrorragia con grave compromiso hemodinámico. Se encontraba en estudio por presentar un hemangioma en el miembro inferior izquierdo que se extendía hasta la región pelviana. La uretrocistofibroscopía demostró la presencia de múltiples lesiones angiomatosas diseminadas en forma amplia en la vejiga, algunas de ellas con sangrado activo. La angioresonancia mostró una voluminosa formación hipervascularizada en contacto con la pared vesical a la cual desplazaba y fístulas arteriovenosas a nivel pelviano y en el miembro inferior izquierdo confirmando el diagnóstico etiológico. Se realizó una embolización arterial selectiva de los territorios ilíacos interno y externo e inmediatamente después una endocoagulación láser de los focos angiomatosos sangrantes. La hematuria remitió completamente en las 24 h posteriores al procedimiento. La metrorragia asociada al SKTW fue controlada mediante la utilización de análogos LHRH y progestágenos.

Klippel-Trenaunay-Weber syndrome (KTWS) is a rare venous malformation that generally affects the lower limbs and, more infrequently, the upper limbs. It is characterized by cutaneous angiomatous formations, varicose veins and hypertrophy of the affected limb. The involvement of the genitourinary tract is extremely infrequent. We expose the case of a 14 years old female patient who was admitted for macroscopic hematuria of 48 hours of evolution and metrorrhagia with severe hemodynamic decompensation. The patient was under study for presenting a hemangioma in the lower left limb that extended to the pelvic region. Urethrocystofibroscopy showed the presence of multiple wide-spread angiomatous lesions in the bladder, some of them with active bleeding. The angio-resonance showed a voluminous hypervascular formation in contact with the bladder wall showing several arteriovenous fistulas at the pelvic level and in the left lower limb confirming the etiological diagnosis. A selective arterial embolization of the internal and external iliac territories was performed and then, a laser endocoagulation of the bleeding angiomatous foci was carried out. The hematuria completely stopped within 24 hours later of the procedure. The metrorrhagia associated with KTWS was controlled by the use of LHRH analogs and progestogens.

Colesterolosis vesicular: algunos aspectos de su fisiopatología / Vesicular cholesterolosis: some aspects of its pathophysiology

Gallbladder cholesterolosis is a nosological clinical entity where the central element is the deposit of lipids in immune cells that reside under the gallbladder epithelium. The mechanisms involved in its development are not entirely clear, but they seem to have some resemblances that are observed in the wall of the arteries with atherosclerosis. The lipid-laden cells observed in the gallbladder wall appear to share many of the characteristics of atherosclerosis foam cells, which by means of scavenger receptors have endocited oxidized low-density lipoproteins and accumulate them in their cytoplasm. Foam cells, in themselves, are not dangerous, but in atherosclerosis at least they can become a problem when they are located in vessels and specific anatomic sites. The role they may have in the gallbladder is not known to date. We will review some considerations that seem relevant to us to elucidate if these entities share the same protagonist: macrophages transformed by modified lipids. (AU)

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.

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.

Gallbladder Tuberculosis: CT Findings with Histopathologic Correlation

OBJECTIVE: We wanted to describe the computed tomography (CT) findings of gallbladder tuberculosis (TB) and to correlate them with pathologic findings. MATERIALS AND METHODS: There were seven patients (M:F = 3:4; mean age, 46.3 years; age range, 32 to 78 years) in whom gallbladder TB was eventually diagnosed. All of them underwent cross-sectional imaging with CT, a pathologic examination and a retrospective review. CT imaging evaluation was done in each case, including the findings of a mass versus nodule, wall thickening (uniform or irregular) and the enhancement patterns (homogeneous or heterogeneous). RESULTS: All the cases of gallbladder TB revealed the following three different CT findings: micronodular lesion of the gallbladder wall (n = 1), a thickened wall (n = 4) and a gallbladder mass (n = 2). There were three cases of homogeneous enhancement of the lesions, including homogeneous enhancement with nodular lesion, homogeneous uniform thickness enhancement and homogeneous thickness enhancement in one case each, and these cases pathology showed tuberculous granuloma with a little caseating necrosis in one case and tuberculous granuloma with rich fibrous tissue, but little or no evident caseating necrosis in two cases. Four cases of heterogeneous enhancement of the lesions, including heterogeneous uniform-thickness enhancement in two cases, heterogeneous enhancement with a local mass lesion in one case and heterogeneous enhancement with a mass that replaced the gallbladder in one case; in these cases, pathology showed tuberculous granuloma with marked caseation or liquefaction necrosis in three cases and tuberculous granuloma by fibrous and calcifications accompanied by caseating necrosis in one case. Among the seven cases of gallbladder TB, six cases were accompanied by abdominal extra-gallbladder TB, including abdominal lymph node TB in five cases and hepatic TB in four cases. CONCLUSION: Gallbladder TB has various CT manifestations, and the enhanced CT findings are well matched with pathological features. An irregularly thickened gallbladder wall or a gallbladder wall mass with multiple-focus necrosis or calcifications accompanied by the typical CT findings of abdominal extra-gallbladder TB should suggest the diagnosis of gallbladder TB.

Coristoma pancreático en la vesícula biliar / Heterotopic pancreas found in the gallbladder: report of one case

We report a 54 years old woman presenting with pain in the right upper abdominal quadrant. An abdominal ultrasound showed multiple gallbladder stones. The patient was operated with the diagnosis of cholelithiasis. During the pathological study of the excised gallbladder a 0.9 cm diameter yellowish nodule was found, that corresponded to heterotopic pancreatic tissue.

La heterotopía pancreática corresponde a la presencia de tejido pancreático fuera de su localización habitual, que carece de continuidad anatómica y vascular con el páncreas normal; el 85 por ciento a 90 por ciento de los casos reportados comprometen estómago, duodeno o yeyuno, mientras que la localización en vesícula biliar es infrecuente y corresponde tan sólo al 1 por ciento de ellas. Esta entidad es generalmente asintomática y en la mayoría de los casos su diagnóstico constituye un hallazgo incidental durante el examen anatomo-patológico de la pieza quirúrgica. Se presenta el caso de una mujer de 54 años sometida a colecistectomía abierta electiva con el diagnóstico de colecistolitiasis. El examen anatomo-patológico de la pieza operatoria, junto con diagnosticar la colecistitis crónica litiásica, describe la presencia de tejido pancreático heterotópico en el espesor de la pared y a nivel del cuello de la vesícula biliar compuesto por acinos y conductos pancreáticos.

Colecistectomía laparoscópica con trócar umbilical único de 12 mm y óptica con canal operatorio: asistido con agujas percutaneas y dispositivos magneticos: reporte de 80 casos / Laparoscopic cholecystectomy with single umbilical trocar of 12mm and an optical device with a working cannel: assisted with percutaneous needles and magnetic devices: report of 80 cases

Presentar nuestra experiencia en la técnica de colecistectomia laparoscópica con trócar umbilical único. Sede: Departamento de Cirugía General de dos hospitales privados. Diseño: estudio prospectivo, observacional. 80 pacientes intervenidos quirúrgicamente con la técnica de colecistectomía laparoscópica con trócar umbilical único de 12mm y óptica con canal operatorio, 74 asistidos con agujas, percutáneas y 6 añadiendo dispositivos magnéticos, desde octubre 2008 al 31 de agosto del 2010. Se excluyeron casos de coledocolitiasis, cáncer y pacientes con cirugías abdominales previas. Se analizó edad, sexo, índice de masa corporal (IMC), tiempo quirúrgico, estancia hospitalaria, complicaciones, índice de conversión y resultado estético. Predomino el sexo femenino (5 a 1). La edad promedio fue de 41 años. El tiempo quirúrgico promedio fue de 63 minutos. IMC promedio 29. Adición de trócar en 7 pacientes (9%), no hubo conversiones a técnicas abiertas. El tiempo de hospitalización fue de 24 horas. Sin cicatriz abdominal visible en 73 pacientes en los que se completó el procedimiento por un trócar (91%). Morbilidad=3,75%, mortalidad=0%. La colecistectomía con trócar umbilical único y óptica con canal de trabajo asistida con agujas percutaneas es aplicable en el 91% de los pacientes con enfermedad vasicular. Con los imanes se logró tracción satisfactoria de la vesícula, siendo de mucha utilidad al realizar la técnica "cirugía sin huella".

To present our experience in the technique of laparoscopic cholecystectomy with single umbilical trocar. Headquarters: Departament of General Surgery of two private hospitals Design: Prospective, observational study. 80 patients operated with the techniqué of laparoscopic cholecystectomy with single umbilical trocar of 12mm and an optical device with a working channel: 74 attended with percutaneous needles and 6 adding magnetic devices, from Octuber 2008 to August 31, 2010. Cases of choledocholithiasis, cancer and patients with previous abdominal surgery were excluded. Age, sex, body mass index (BMI), surgical time, hospital stay, complications, index of conversión and cosmetic result were analyzed. Feminine sex predominated (5 to 1). The average age was 41 years. The surgical time average was 70 minutes. IMC average 29. Addition of trocars was need in 7 patients (9%), there were no conversion to open surgery. The hospitalization time was 24 hours. Abdominal scar was not visible in 73 patients in whom the precedure with one trocar was completed (91%). Morbidity=3.75%, mortality=0%. The laparoscopic cholecystectomy with single umbilical trocar of 12mm and an optical device with a working cannel attended with percutaneous needles is applicable in 91% of patients with gallbladder disease. With magnets satisfactory traction of the gallbladder was obtained, being very useful to per-form the technique "surgery without trace".

Pólipos da vesícula biliar: como e quando tratar? / Management of gallbladder polyps

OBJETIVO: O objetivo do estudo é saber qual a orientação terapêutica para os doentes com pólipos vesiculares (PVs), que tipo de vigilância realizar, saber diferenciar entre um pólipo benigno e um pólipo maligno e proporcionar uma tranquilização em relação à "cancrofobia". Tipo de estudo: Realizou-se um estudo retrospectivo de cinco anos. Local: O estudo foi realizado nos Hospitais da Universidade de Coimbra, num Serviço de Cirurgia. População: Foram estudados todos os doentes operados no Serviço de Cirurgia II com o diagnóstico pré-operatório de PV, entre janeiro de 2003 e dezembro 2007. MÉTODOS: Foi feita correlação clínico-patológica de todos os doentes. Feita avaliação: de dados demográficos, da apresentação clínica, dos principais sintomas, das patologias associadas e exames complementares de diagnóstico realizados. RESULTADOS: Foram estudados 93 doentes, sendo que em 91 doentes tratava-se de pólipos benignos e em dois doentes de pólipos malignos. Dos 91 pólipos benignos, 73 (78,5 por cento) eram pólipos de colesterol, 14 (15 por cento) hiperplasias e dois (2,2 por cento) adenomas. Em dois (2,2 por cento) doentes tratava-se de pólipos malignos, adenocarcinoma da vesícula biliar. O diâmetro médio dos pólipos benignos é de 6 mm, 40 (43 por cento) doentes apresentavam lesões múltiplas. Nos pólipos malignos e pré-malignos (adenomas) o diâmetro médio é de 18,8 mm, são todas lesões solitárias e a idade média destes doentes é de 57,7 anos. CONCLUSÃO: Conclui-se que o tratamento cirúrgico dos PVs é a colecistectomia e só deve ser realizado quando existe: clínica relacionada com o PV; pólipos de diâmetro superior a 10 mm; crescimento do pólipo num curto espaço de tempo; pólipo séssil ou base de inserção larga; pólipo com longo pedículo; idade do doente superior a 50 anos; coexistência de litíase vesicular; pólipos localizados no infundíbulo da vesícula ou alterações ecográficas na parede vesicular.

OBJECTIVE: Appropriate treatment and timing hinge on whether the lesion is benign or malignant. Study: A five years retrospective descriptive analysis was performed. Location : Department of General Surgery in Hospitals of the University of Coimbra. Patients: We present a series of 93 consecutive patients who had elective surgery for known gallbladder polyps, treated from January 2003 to December 2007. METHODS: An analysis was performed using clinical and radiological files of patients electively treated for gallbladder polyp. Ninety-three consecutive patients were evaluated, treated and followed in a Department of General Surgery in a Central Hospital in that period. Biographic, clinical and radiological data were compiled. RESULTS: In 91 patients a benign lesion was found. Two (2.16 percent) patients had adenocarcinoma. Among benign polyps, 73 (78,5 percent) were cholesterol polyps, 14 (15 percent) were hyper-plastic and 2 (2.19 percent) were premalignant adenomas. Mean diameter of benign polyps, excluding adenomas, was 6 mm. In 40 (43 percent) patients, multiple lesions were found. The mean diameter in the subset of malignant and premalignant polyps was 18.8 mm, in all instances these were found to be single lesions; and mean age at presentation was 57,7 years. CONCLUSION: Cholecystectomy is the appropriate surgical treatment for gallbladder polyps, when removal is warranted. Patients benefitting from surgery are those who are symptomatic, whose polyps exceed 10 mm in diameter and , have shown to be enlarging, to be sessile or broad-based, to have long pedicles;and also have . infundibular polyps, coexisting gallstones or changes on the gallbladder wall appearance at ultrasonography.

Are histological alterations observed in the gallbladder precancerous lesions?

INTRODUCTION: Gallbladder cancer, which is characterized by rapid progression and a poor prognosis, is a complex disease to treat. Unfortunately, little is known currently about its etiology or pathogenesis. A better understanding of its carcinogenesis and determining risk factors that lead to its development could help improve the available treatment options. METHOD: Based on this better understanding, the histological alterations (such as acute cholecystitis, adenomyomatosis, xanthogranulomatous cholecystitis, polyps, pyloric metaplasia, intestinal metaplasia, dysplasia, cancer and others) in gallbladders from 1,689 patients who underwent laparoscopic cholecystectomy for cholecystolithiasis were analyzed. The association of these gallbladder histological alterations with clinical data was studied. RESULTS: Gender analysis revealed a greater incidence of inflammatory changes in males, while dysplasia and cancer were only found in women. The incidence of cholesterolosis was greater in the patients 60 years of age and under, and the incidence of adenomyomatosis and gangrene was greater in the elderly patients. A progressive increase in the average age was observed as alterations progressed through pyloric metaplasia, intestinal metaplasia, dysplasia and then cancer, suggesting that the metaplasia-dysplasia-carcinoma sequence may occur in gallbladder cancer. Gallbladder histological alterations were also observed in asymptomatic patients. CONCLUSION: The results of this study suggest that there could be an association between some histological alterations of gallbladder and cancer, and they also suggest that the metaplasia-dysplasia-carcinoma sequence could in fact be true in the case of gallbladder cancer. Nevertheless, further studies directed towards a perfect understanding of gallbladder carcinogenesis are required.

A Case of Hemocholecyst / 대한소화기학회지

No abstract available.

Hyponatremia and Mortality among Patients on the Liver-Transplant Waiting List / 대한소화기학회지

No abstract available.

Coristoma pancreático en la vesícula biliar: Reporte de dos casos / Pancreatic choristoma in the gallbladder: Report of two cases

Pancreatic choristoma is the ocurrence of normal pancreatic tissue in an abnormal location without any anatomic continuity with the main body of the gland. Although heterotopia is uncommon in the gallbladder and biliary tract, anecdotic cases of gastric mucosa, liver, adrenal gland and pancreas among other tissues have been described. We report an eight year-old male and a 22 year-old female, electively operated for symptomatic cholelithiasis. On pathology, a nodule identified as a pancreatic endocrine and exocrine choristoma, was found in the gallbladder wall of both patients. We employed immunohistochemistry to characterize this choristoma. Tubular and epithelial structures were immunoreactive to cytokeratins 7, 8, 18, 19 and 20 and to CA19-9. Exocrine activity was documented by immunoreactivity to al-antitrypsin and al-chemotrypsin. Other immunohistochemical markers such as insulin and somatostatin were positive identifying endocrine activity.

Naturaleza de los pólipos de la vesícula biliar sometidos a colecistectomía / Clinical and pathological features of gallbladder polyps

Existen distintos protocolos para el manejo de los pólipos vesiculares, colecistectomía para todo paciente con pólipo vesicular, sólo para sintomáticos, o para aquellos que midan sobre 10 mm. El objetivo de este trabajo es aportar datos que contribuyan a optar entre colecistectomía sistemática o selectiva, caracterizando los pólipos vesiculares, especialmente en relación a la presencia de adenocarcinoma. Se realizó un estudio descriptivo revisando 118 fichas de todos los pacientes con pólipos vesiculares colecistectomizados en Hospital Naval Almirante Nef entre Enero de 1995 y Diciembre de 2004. La frecuencia de pólipos fue 3,1 por ciento. La relación hombre mujer fue 1:1.1. El tamaño promedio fue 4.1 mm. El 54,2 por ciento fueron hallazgos en el estudio anátomo-patológico. Los pólipos de colesterol (67,9 por ciento) y los hiperplásticos (20,3 por ciento) fueron los más frecuentes. Los adenomas correspondieron al 9,3 por ciento. Encontramos 3 pacientes con cáncer vesicular in situ (2,5 por ciento) en pólipo adenomatoso, 2 asociados a litiasis. La frecuencia de pólipos encontrada en nuestro estudio es superior a otras publicaciones. Destaca una menor diferencia en la proporción hombre mujer. Nos parece importante el hallazgo de cáncer en pólipos adenomatosos de 5 mm, incluso en un caso no asociado a litiasis. Aunque el porcentaje de cáncer en pólipos no asociados a litiasis vesiculares bajo (2,1 por ciento), el hallazgo de dos casos con pólipos de 5 mm (uno no asociado a litiasis), cuestiona una conducta contemplativa, enfatizando la necesidad de vigilancia ecográfica, e incluso plantea la posibilidad de considerar la colecistectomía laparoscópica como un método diagnóstico y terapéutico adecuado frente a todo pólipo vesicular.

Coristoma hepático en la pared de la vesícula biliar: report of one case / Hepatic choristoma in the gallbladder wall

El tejido hepático heterotópico es una condición poco común que se identifica con mayor frecuencia durante la exploración quirúrgica del abdomen por otras indicaciones. Describimos un caso de tejido hepático heterotópico localizado en la pared externa de la vesícula biliar de un paciente masculino de 47 años de edad, en el cual se realizó una colecistectomía laparoscópica porcolelitiasis sintomática. El reporte histopatológico informa de cambios crónicos en la pared vesicular y leve infiltrado linfocitario difuso en el corion de la mucosa y muscularis mucosae sin compromiso inflamatorio o infiltración por otros tejidos. El nodulo hepático compromete solo la serosa y mide 12x8x6 mm, la arquitectura es típica del parénquima hepático con su arquitectura lobulillar conservada y leve hiperemia centrolobulillar difusa. Aún cuando el coristoma hepático de nuestro paciente constituye un hallazgo inesperado, es importante destacar las implicaciones patológicas de este tejido y el potencial de malignidad asociado al mismo.

Gastric heterotopia together with squamous metaplasia in the gallbladder / Heterotopía gástrica y metaplasia escamosa en la vesícula biliar

Heterotopic gastric mucosa in the gallbladder is extremely unusual. In this study, we aimed to report a case of gastric heterotopia together with squamous metaplasia in the gallbladder of a 47-year-old female patient who experienced an intensive abdominal pain. He was admitted to the hospital for clinical treatment without any improvement. Ultrasonography showed a stone located in the gallbladder neck and dilatation of intrahepatic bile ducts, both hepatic ducts and common hepatic duct. Laparoscopic cholecystectomy was performed. In the microscopical examination, the epithelium of the gallbladder revealed an unspecified chronic cholecystitis. Besides, at the level of the gallbladder body, a heterotopic gastric mucosa contain chief, parietal and mucosal cells with cystic glands and squamous metaplasia was found. Actually the patient is in long-time follow-up, asymptomatic. We also review 96 other reports of HGM in the gallbladder in the international medical literature from 1934. As heterotopic tissue may promote carcinogenesis of the gallbladder, close attention should be paid to any occurrence of such lesions in this anatomical region. It appears that laparoscopic cholecystectomy may be unavoidable for patients affected by heterotopic gastric mucosa at the present time and care must be taken when a diagnosis is made based on intraoperative frozen sections.

La heterotopía de la mucosa gástrica (HGM) en vesícula biliar es extremadamente rara. En este estudio, reportamos un caso de heterotopía gástrica junto con metaplasia escamosa en vesícula biliar de un paciente femenino de 47 años que experimentó un dolor abdominal intenso. Lo admitieron al hospital para el tratamiento clínico sin ninguna mejoría. Ultrasonografía demostró un cálculo situado en el cuello de la vesícula y dilatación de conductos biliares intrahepáticos, los conductos hepáticos y conducto hepático común. Se realizó la colecistectomía por vía laparoscópica. En el exámen microscópico el epitelio reveló una colecistitis crónica inespecífica. Además, en el nivel del cuerpo de la vesícula biliar fue hallada una mucosa gástrica heterotópica con células principales, parietales, células mucosas con las glándulas enquistadas y metaplasia escamosa. El paciente está en el seguimiento a largo plazo, asintomático. Revisamos 96 informes de HGM en vesícula biliar en la literatura médica internacional a partir de 1934. El tejido heterotópico puede promover la carcinogénesis de la vesícula biliar, por lo cual se debe prestar atención a cualquier ocurrencia de tales lesiones en esta región anatómica. La colecistectomía laparoscópica puede ser inevitable para los pacientes afectados por la mucosa gástrica heterotópica actualmente y todo cuidado debe ser tomado cuando se hace un diagnóstico por secciones congeladas intraoperatorias.

Management of polypoidal lesions of gallbladder in laparoscopic era.

The detection of polypoidal lesion of gallbladder (PLG) has increased particularly with widespread use of ultrasonography (US) as a diagnostic modality. Most of the PLG are diagnosed incidentally during scanning. Differentiation of benign from malignant PLG is a major concern and further management is based on this differentiation. DATA SOURCE: A Pubmed database search was performed. Abstract and articles were reviewed in detail. Other references were extracted by cross-reference. CONCLUSION: The risk factors for malignancy in PLG are identified. The newer investigative procedures may differentiate benign from malignant PLG. Follow up of the asymptomatic patient and indication for surgery is established in PLG.

Torsion of the Gallbladder: Report of a Case

Torsion of the gallbladder is a rare entity that is difficult to diagnose preoperatively. The condition occurs most often in the elderly. Although its etiology is unknown, a constant finding is the presence of the gallbladder on a mobile mesentery (floating gallbladder). Torsion, or volvulus, of the gallbladder occurs when it twists axially, with the subsequent occlusion of bile and/or blood flow. Herein, a case of torsion of the gallbladder is presented where preoperative computed tomographic scan and laparoscopy were successfully used to diagnose and treat this condition without the usual requirement of open exploration. Given the possibility of laparoscopic cholecystectomy and the increasing incidence with which torsion of the gallbladder is being witnessed today, the importance of a preoperative computed tomographic scan is emphasized when there is a high index of clinical suspicion.

Identificación de flora bacteriana en cultivos de bilis de pacientes sometidos a cirugía billar / Identification of bacterial flora in bile cultures of patients subjected to billar surgery

Se realizó un estudio prospectivo entre julio de 1999 y julio de 2001, en 50 pacientes de ambos sexos, realizándose en cada uno cultivo de bilis vesicular y coledociano, con edades comprendidas entre los 16 y 80 años, hospitalizados en el Servicio de Cirugía del Hospital Chiquinquirá de Maracaibo con diagnóstico de patología biliar no aguda, litiásica o no litiásica para ser intervenidos en el árbol biliar, con el propósito de determinar la frecuencia de infección biliar, establecer la sensibilidad antibiótica específica de las bacterias en cultivos de bilis, reducir el costo del gasto terapéutico e identificar los especímenes más frecuentes. Las edades más afectadas son la tercera y cuarta década de vida. El sexo femenino es el más afectado, con 96 por ciento de los pacientes objeto de estudio. El número de cultivos positivos fue significativamente alto (35 por ciento). Los cultivos de bilis vesicular y del conducto colédeco en los cuales hubo crecimiento bacteriano fueron aproximadamente iguales, 18 (36 por ciento), contra 17 (34 por ciento). Los microorganismos aislados en más ocasiones fueron las bacterias aerobias 9 (35 por ciento), y de éstas las que crecieron con más frecuencia fueron las especies gram negativas (77,8 por ciento), de estas últimas la que más se aisló fue Escherichia coli en 28,5 por ciento. Las bacterias del tipo bacilos gram negativos se reportaron sensibles a los aminoglicósidos y quinolomas, con sensibilidad a betalactámicos que se administran asociados a los compuestos inhibidores de la enzima talactamasa. Los enterococos gram positivos aislados se mostraron sensibles a penicilina y sus derivados naturales y sintéticos, así como a los asociados a los inhibidores de betalactamasa. Las bacterias anaerobias que crecieron se reportaron sensibles a penicilinas y cefalosporinas de tercera y cuarta generación, así como a estos betalactámicos asociados a los inhibidores de la enzima betalactamasa