Value of Contrast-enhanced Ultrasound in Differential Diagnosis between Cholesterol Polyp and Gallbladder Adenoma / 中国医学科学院学报

Objective To compare the performance of contrast-enhanced ultrasound(CEUS)and ultrasound(US)in the differential diagnosis between cholesterol polyps and gallbladder adenomas. Methods A total of 136 patients with gallbladder polyp lesions(GPLs)and undergoing cholecystectomy in the First Medical Center of Chinese PLA General Hospital from January 2019 to October 2020 were retrospectively analyzed.All the patients underwent US and CEUS examinations before cholecystectomy.US and CEUS images of cholesterol polyps and gallbladder adenomas were compared for the evaluation of the performance of CEUS in the diagnosis of gallbladder adenomas. Results The 136 cases of GPLs included 95 cases of cholesterol polyps and 41 cases of gallbladder adenomas.Cholesterol polyps and gallbladder adenomas showed significant differences in the maximum size of GPLs(

Vesícula biliar gigante / Giant gallbladder

Se registra el caso de una paciente femenina de 73 años con antecedente de colecistitis crónica, quien al examen físico presentaba una tumoración palpable en hipocondrio derecho que se extendía a fosa ilíaca derecha. La ecografía abdominal mostró aumento del tamaño vesicular que alcanzaba fosa ilíaca derecha con contenido multilitiásico; se confirmó dicho hallazgo con estudio tomográfico. Se realizó laparotomía exploradora con hallazgo operatorio de vesícula gigante de paredes engrosadas, tensa, adherida a órganos circundantes, de dificultosa disección, que requirió punción para drenaje de su contenido. Se efectuó, además, colecistectomía convencional según técnica de Pribram, y se obtuvo una pieza quirúrgica de aproximadamente 15 × 10 cm, con informe de anatomía patológica de colecistitis crónica. En contraste con la presentación habitual de la colecistitis crónica, el caso de referencia obedece a una presentación atípica con una vesícula gigante.

We report the case of a 73-year old female patient with a history of chronic cholecystitis with a palpable mass extending from the right hipochondrium to the right iliac region. An abdominal ultrasound showed an enlarged gallbladder extending to the right iliac region with multiple gallstones confirmed by computed tomography scan. An exploratory laparotmy was performed. A giant gallbladder with thickened walls and presence of adhesions to the neighbor organs that were difficult to remove were found and required drainage. A conventional cholecystectomy was performed using the Pribram's technique. A surgical specimen measuring 15 x 10 cm was sent to the pathologist who made a diagnosis of chronic cholecystitis. This case is an atypical presentation of chronic cholecystitis due to a giant gallbladder.

Vólvulo de vesícula biliar / Gallbladder volvulus

El vólvulo de la vesícula biliar es una enfermedad rara y poco frecuente de difícil diagnóstico de manera preoperatoria, ya que las manifestaciones clínicas son atribuidas a otras enfermedades. Se presenta un caso de una paciente femenina de 84años de edad que ingresó en el servicio de cirugía general con un cuadro de dolor abdominal a tipo cólico en hipocondrio derecho acompañado de náusea y vómitos con restos de alimentos. Se realizó examen físico y se indicó ultrasonido abdominal. Se interpretó como una colecistitis aguda litiásica. Se impuso un tratamiento con ceftriaxone. Dado su evolución no desfavorable, cinco días después de su ingreso se realizó la colecistectomía donde se encuentra órgano volvulado. La biopsia confirma colecistitis aguda gangrenada. La paciente evolucionó satisfactoriamente. Tres días posteriores a la cirugía egresó de la institución(AU)

Gallbladder volvulus is a rare and infrequent disease difficult to diagnose preoperatively, as clinical manifestations are attributed to other diseases. A case is presented of an 84-year-old female patient who entered the general surgery service with abdominal colicky pain to the right hypochondrium accompanied by nausea and vomiting with food remains. A physical examination was performed and abdominal ultrasound was indicated. It was interpreted as acute lithiasic cholecystitis. Ceftriaxone was prescribed. Given the unfavorable evolution five days after admission, the cholecystectomy was performed, where the volvulus was found. The biopsy confirms acute gangrenous cholecystitis. The patient evolved satisfactorily. Three days after the surgery he was discharged from the institution(AU)

Características ultrassonográficas de fígado, vesícula biliar, rins, vesícula urinária e jejuno em coelhos jovens e adultos / Ultrasound features of liver, gallbladder kidneys, urinary bladder and jejunum in young and adult rabbits

O presente trabalho descreveu características e comparou mensurações do fígado, vesícula biliar, rins, vesícula urinária e jejuno de coelhos da raça Nova Zelândia Branco (NZB) jovens e adultos. O grupo dos jovens foi composto por 39 coelhos de ambos os sexos (20 machos e 19 fêmeas), desmamados aos 30-31 dias de idade, sendo as avaliações realizadas aos 35, 56 e 77 dias de idade. O grupo dos adultos foi composto por 23 fêmeas e 15 machos, com idade superior a 6 meses, sendo realizada uma avaliação ultrassonográfica por animal. O exame consistiu na avaliação do fígado, vesícula biliar, rins direito e esquerdo, jejuno e vesícula urinária. Todos os animais foram pesados antes dos exames. O peso médio dos animais aumentou (p<0,05) dos 35 dias até a idade adulta. Tanto nos adultos quanto nos jovens, o fígado apresentou-se predominantemente isoecogênico ao rim direito e com textura homogênea. A vesícula biliar apresentou-se em formato ovoide alongado, variando de piriforme à amendoado, com conteúdo anecogênico, não sendo visível em 2,6% dos coelhos jovens e em 26,3% dos adultos. O comprimento e a largura da vesícula biliar nas idades de 35, 56, 77 dias e adultos foram: 1,06 e 0,39; 1,44 e 0,53; 1,41 e 0,58; 1,57 e 0,67cm, respectivamente. Considerando jovens e adultos, as mensurações da vesícula biliar e dos rins esquerdo e direito apresentaram correlação positiva (p<0,05) com o peso. Os rins apresentaram-se no formato de elipse e com superfície regular, com aumento (p<0,05) dos 35 dias à idade adulta. Houve correlação positiva (p<0,05) entre os volumes renais direito e esquerdo. A descrição da vesícula urinária mais encontrada (86%) foi a com conteúdo anecogênico, com pequenas estruturas ecogênicas livres no lúmen, tanto em jovens quanto em adultos. Não houve diferença (p>0,05) da espessura das camadas do jejuno entre as idades, apresentando média de 0,23 cm para todos os animais. Estes são os primeiros dados brasileiros de características ultrassonográficas de fígado, vesícula biliar, rins, jejuno e vesícula urinária para coelhos NZB de 35, 56 e 77 dias de vida e adultos.(AU)

This study described characteristics and measurements of the liver, gallbladder, kidney, urinary bladder and jejunum of young and adults New Zealand White (NZW) rabbits. The young rabbits's group was composed of 39 rabbits of both sexes (20 males and 19 females), weaned at 30-31 days of age, and the evaluations carried out at 35, 56 and 77 days of age. The adults group was composed of 23 females and 15 males, with more than 6 months of age, and one ultrasonographic evaluation per animal. The exam consisted in the evaluation of liver, gallbladder, right and left kidneys, jejunum and urinary bladder. All the animals were weighed before the evaluations. The average weight increased (p<0.05) from 35 days to adults. Both in adult and in young rabbits, the liver presented predominantly isoechogenic in relation of right kidney and with homogeneous texture. The gallbladder had an elongated ovoid shape, ranging for pear-shaped to almond, with anechogenic content, not being visible in 2.6% of young rabbits and 26.3% of adults. The length and width were 1.06 and 0.39; 1.44 and 0.53; 1.41 and 0.58; 1.57 and 0.67cm, respectively at 35, 56, 77 days and adults. For young and adults rabbits, the gallbladder and the left and right kidneys were positively correlated (p<0.05) with weight. The kidneys had an ellipse shape with smooth surface, increasing (p>0.05) from 35 days to adulthood. There was a positive correlation (p<0.05) between the right and left kidney volumes. The description of urinary bladder more frequently (86%) observed was anechogenic content, with small free echogenic structure within the lumen, both in young and in adult rabbits. There was no difference (p>0.05) in the thickness of the layers of the jejunum among ages, with the mean of 0.23cm for all animals. With the results, the first Brazilian ultrasonographic data for liver, gallbladder, kidney, jejunum and urinary bladder were defined to NZW rabbits in 35, 56 and 77days of life, as well as adults.(AU)

Agenesia de la Vesícula Biliar asociada a pancreatitis aguda recurrente. Presentación de caso / Gall bladder agenesis associated with recurrent acute pancreatitis. Case presentation

Introducción: La Agenesia de la Vesícula Biliar es una anomalía congénita rara, entre 13 y 65 por ciento por cada 100 000 habitantes. Su asociación con pancreatitis aguda es extremadamente rara. Objetivo: Presentar un caso de Agenesia de la Vesícula Biliar asociada a pancreatitis aguda recurrente. Presentación del caso: Se presenta una mujer de 85 años, con antecedentes de litiasis vesicular por ultrasonido (US), y crisis de dolor abdominal, vómitos e hipotensión frecuentes, a quien remitían con tratamiento médico. Acudió al hospital con dolor abdominal, vómitos e hipotensión. Al examen físico se constató: dolor epigástrico, sin reacción peritoneal ni tumor palpable. El US informó vesícula no visible. En menos de 24 horas evolucionó con shock, disfunción múltiple de órganos y muerte. En la necropsia se encontró Agenesia de la Vesícula Biliar (AVB) y pancreatitis aguda necrotizante. Conclusiones: La AVB es una anomalía congénita rara, de difícil diagnóstico preoperatorio, por lo que casi siempre es un hallazgo de la cirugía abdominal o en la autopsia. Su asociación con pancreatitis aguda es rara. La pancreatitis puede ser debida a Disfunción del Esfínter de Oddi o de origen idiopático(AU)

Introduction: Gallbladder agenesis (GA) is a rare congenital anomaly, with a reported incidence ranging between 13-65 percent a 100 000 population. Its association with acute pancreatitis is extremely rare. Objective: To present a case of GA associated with recurrent acute pancreatitis. Case Presentation: We present an 85 years old woman whose clinical record reported a bladder stonediagnosis by US, that arrive to the hospital with frequent episodes of intermittent vomiting, abdominal pain and hypotension. She was admitted at hospital with upper abdominal pain, vomiting and hypotension. At the physical examination the abdomen was soft, with mild epigastric tenderness, without tenderness rebound or tumor. US report gallbladder not visible. In less than 24 hours the patient evolved with shock, multiple organ failure and death. Gallbladder agenesis and acute pancreatitis were found in autopsy. Conclusions: The GA is a rare congenital anomaly, difficult to establish a correct preoperative diagnosis, always found during the abdominal surgery or autopsy. Its association with acute pancreatitis is very uncommon. Pancreatitis may be due to of Oddi Sphincter's Dysfunction (SOD) or idiopathic origin(AU)

Duplicación de la vesícula biliar / Gallbladder duplication

Gallbladder duplication is a rare congenital anomaly and, like other biliary malformations, is associated with an increased risk of complications in the laparoscopic cholecystectomy We present a case of a woman consulting in the emergency department for clinical symptoms compatible with acute cholecystitis. An abdominal ultrasound is performed confirming the clinical suspicions, observing the typical findings. Pathological dilatation of the extrahepatic biliary tract is also confirmed, therefore she is evaluated with MR cholangiography, which also confirms signs compatible with acute cholecystitis; the presence of a cystic formation of saccular morphology in an intrahepatic location was identified, with the same structure as the gallbladder, but smaller in size and with a duct of its own that drained into the common hepatic duct independently to the cystic duct of the inflamed vesicle.

La duplicación de la vesícula biliar es una anomalía del desarrollo poco frecuente, y al igual que otras malformaciones de la vía biliar, se asocia a un mayor riesgo de complicaciones en la colecis-tectomía laparoscópica. Se presenta un caso de una mujer que consulta en el servicio de urgencia por cuadro clínico compatible con colecistitis aguda. Se realiza una ecografía abdominal que confirma la presunción clínica, observándose los hallazgos típicos. Se constata además dilatación patológica de la vía biliar extrahepática, por lo que se evalúa con colangiorresonancia, que además de confirmar los signos compatibles con la colecistitis aguda, se identificó la presencia de una formación quística de morfología sacular en situación intrahepática, de igual morfología que la vesícula biliar, pero de menor tamaño y con un conducto propio que drenaba al conducto hepático común en forma independiente al conducto cístico de la vesícula inflamada.

Ultrasonographic Diagnosis of Biliary Atresia Based on a Decision-Making Tree Model

OBJECTIVE: To assess the diagnostic value of various ultrasound (US) findings and to make a decision-tree model for US diagnosis of biliary atresia (BA). MATERIALS AND METHODS: From March 2008 to January 2014, the following US findings were retrospectively evaluated in 100 infants with cholestatic jaundice (BA, n = 46; non-BA, n = 54): length and morphology of the gallbladder, triangular cord thickness, hepatic artery and portal vein diameters, and visualization of the common bile duct. Logistic regression analyses were performed to determine the features that would be useful in predicting BA. Conditional inference tree analysis was used to generate a decision-making tree for classifying patients into the BA or non-BA groups. RESULTS: Multivariate logistic regression analysis showed that abnormal gallbladder morphology and greater triangular cord thickness were significant predictors of BA (p = 0.003 and 0.001; adjusted odds ratio: 345.6 and 65.6, respectively). In the decision-making tree using conditional inference tree analysis, gallbladder morphology and triangular cord thickness (optimal cutoff value of triangular cord thickness, 3.4 mm) were also selected as significant discriminators for differential diagnosis of BA, and gallbladder morphology was the first discriminator. The diagnostic performance of the decision-making tree was excellent, with sensitivity of 100% (46/46), specificity of 94.4% (51/54), and overall accuracy of 97% (97/100). CONCLUSION: Abnormal gallbladder morphology and greater triangular cord thickness (> 3.4 mm) were the most useful predictors of BA on US. We suggest that the gallbladder morphology should be evaluated first and that triangular cord thickness should be evaluated subsequently in cases with normal gallbladder morphology.

Clinical Review and Case Report of Ceftriaxone-associated Gallbladder Pseudolithiasis in Adult / 대한소화기학회지

Although ceftriaxone can be used safely in most instances, it can sometimes induce biliary sludge or stone formation. Most of the patients remain asymptomatic and children are more susceptible to develop this condition, but adults can be affected as well. Because sludge or stones disappear after discontinuing ceftriaxone, this condition is referred to as ceftriaxone-associated pseudolithiasis. A 54-year-old woman was admitted to a local clinic for management of ileus. During admission, she had received ceftriaxone and metronidazole, and had been on nil per os for the past 6 days. She was then referred to our hospital for cholecystectomy due to persistent right upper quadrant pain. Although imaging studies showed gallbladder sludge, pseudolithiasis was suspected because of ceftriaxone administration history and prolonged fasting. After careful watch-and-wait, the condition resolved spontaneously after ceftriaxone discontinuation. Our clear understanding on ceftriaxone-associated gallbladder pseudolithiasis allowed us to avoid an unnecessary cholecystectomy. Herein, we report the case of a 54-year-old woman with ceftriaxone-associated gallbladder pseudolithiasis that was successfully managed by ceftriaxone discontinuation alone.

[Gallblader sonographic abnormality following ceftriaxone treatment in children]

Considering the relatively wide application of ceftriaxone in pediatric infectious diseases and its side effects, this study was done to determine gallblader sonographic abnormality following ceftriaxone treatment in children. This descriptive cross-sectional study was carried out on 60 patients age 1 month up to 12 years in Besat hospital, Hamadan, Iran during 2007. The sonographic abnormal finding of gallbladder before ceftriaxone therapy and 5 days after therapy were recorded. In case of any abnormality in gallblader sonography was repeated twice a week in the first two weeks and afterward once a week up to disappearance of abnormalities. Gallblader sonographic abnormality were observed in 10 cases [16.5%]. Out of them, 8 and 2 patients had bile stone and bile sludge, respectivley. The patients did not show any clinical manifestations. There was no relation between age and sex with abnormal findings. Gallblader abnormality completely were disappeared in the worst cases by sixteen days. This study showed that the incidence of either gallstone or biliary sludge after treatment with ceftriaxone was 16.5% which is relatively similar to other studies

Agenesia verdadeira de vesícula biliar: dificuldades no diagnóstico pré-operatório / Real agenesis gallbladder: problems in pre-operative diagnosing

Relata-se um caso de agenesia de vesícula. Paciente, 33 anos, feminino, com dor tipo cólica em hipocôndrio direito, há 3 anos. Baseado na história e no exame de ultrassonografia (US) de abdome, que evidenciou presença de imagens ecogênicas com sombra acústica posterior na topografia da vesícula biliar US, indicou-se a colecistectomia. Durante a laparotomia, notou-se a ausência completa da vesícula biliar em sua anatomia usual. No pós-operatório, foi solicitada uma tomografia computadorizada (TC) de abdome, relatando ausência de vesícula biliar. Essa anomalia é rara e de difícil diagnóstico clínico, com sintomatologia semelhante à colelitíase em até 50% dos casos. Apesar dos avançosdos métodos de imagem para diagnóstico de doenças gastrointestinais, o diagnóstico de agenesia de vesícula ainda é por laparotomia, o que justificam os esforços para implementar métodos diagnósticos pré-operatórios de maior sensibilidade.

The authors report a case-agenesis of vesicle. Patient, 33 years, female, with pain type colic hypochondrium right, for 3 years. Based on history and examination, the ultrasound (US) of the abdomen showed presenceof echogenic images with acoustic shadow later in the topography of gallbladder US, indicating the cholecystectomy. During laparotomy, has been noted complete absence of gallbladder in its anatomy routine. At postoperative was requested a computed tomography (CT) of the abdomen, reporting absence of gallbladder. This anomaly is rare and difficult clinical diagnosis, with similar symptom to cholelithiasis in up to 50% of cases. Despite the progress of imaging methods for diagnosis of gastrointestinal diseases, the diagnosis of agenesis of vesicle is still by laparotomy, which justifying efforts to implement diagnostic methods pre-op for greater sensitivity.

role of preoperative ultrasound in predicting difficulties encountered during laparoscopic cholecystectomy

Pre-operative prediction of difficulties which may occur during laparoscopic cholecystectomy can help in reduction of operative and postoperative complications. The aim of our study was to study the value of preoperative ultrasound findings for predicting difficulties encountered during LC and to assess the usefulness of these findings to identify patients at high risk of conversion from laparoscopic to OC. A prospective study of 200 consecutive patients who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis in the period between October 2005 and March 2007 in Rizgary Teaching and Howler Private Hospitals in Erbil, Kurdistan, Iraq. Abdominal ultrasound was done pre-operatively, the diagnosis of gall stones was made and the presence of ancillary findings was recorded. Five ancillary ultrasound findings were assessed. These included; thickened gall bladder wall more than 4mm, presence of pericholecystic fluid, severely contracted gall bladder, empyma, and gall bladder filled with stones. Ultrasound findings were compared with the operative findings. In 36 patients who had one or more of these findings laparoscopic Cholecystectomy was difficult in 22 [61.1%] of them. The statistical analysis showed that thick wall gall bladder > 4mm has the highest sensitivity [69%] and the presence of pericholecystic fluid has the highest specificity [100%] in predicting difficult laparoscopic cholecystectomy and the presence of more than 2 ancillary findings yielded an accuracy rate of [100%]. Conversion to open cholecystectomy was needed in 13.9% of these patients. The rates of difficult laparoscopic cholecystectomy and conversion to laparotomy were much lower in those patients who had no ancillary findings [4.3%] and [1.2%] respectively. Preoperative ultrasound findings are of value for predicting difficulties encountered during laparoscopic cholecystectomy which may require conversion to open cholecystectomy

Triplication of Gallbladder

Triplication of gallbladder is a very rare congenital anamoly of biliary tract and is unlikely to be revealed unless there are associated symptoms. The modern imaging techniques usually fail to define the exact anatomy. Pre-operative awareness of this anatomic variation can minimize the chances of any damage to the biliary tract. This case report describes a patient with cholelithiasis diagnosed to have double gallbladder on pre-operative ultrasound

Factors associated with gallstones in patients with chronic renal failure treated by haemodialysis in upper Egypt

Studies performed to date on the prevalence of gallstones in chronic renal failure [CRF] on haemodialysis [HD] have given contradictory results. to evaluate the frequency and percentage of gallstones and its main associated risk factors in a group of Egyptian haemodialysis patients. The study included 147 patients with CRF on HD randomly selected from Assiut and Sohag University renal dialysis units in Upper Egypt [102 males, 45 females]. The screening protocol included complete medical history, female parity, as well as, use of estrogen therapy by females. History of diabetes mellitus and duration of haemodialysis were also recorded. Body mass index [BMI] was calculated and a number of biochemical parameters [total cholesterol and triglycerides, serum calcium, phosphorus and uric acid] were estimated in fasting serum. An ultrasound scan of the gall bladder and biliary tract was performed with a 3.5 MHz linear probe after at least 12 h fasting. In addition, the prevalence of gallstones in the general population of the same geographical region was calculated after revising available data in ultrasonography reports. The mean age of CRF patients was 43 +/- 14.2 years and mean duration of dialysis was 30 +/- 30.5 months. Gallstones were diagnosed in 22.4% of HD patients and this was mildly significantly higher in women than men [31.1% in women vs 18.6% in men, P=0.05] and this percentage was significantly higher than that of the general population in the same geograbical region [1.6% of the total examined] [P=0.001]. The percentage of gallstones didnt increase significantly with increasing age or duration of dialysis. We noticed an insignificantly raised risk for gallstones with use of estrogen by females, diabetes mellitus and smoking in males [OR=3.2, 1.6, 1.2 respectively; P >0.05 for all of them]. No significant difference was noted between CRF patients with and without gallstones in the studied biochemical parameters except for mean serum calcium that was significantly higher in patients with gallstones [9.8 +/- 1.3 vs 8.1 +/- 1.1; P=0.04]. The percentage of gallstones in a group of Egyptian patients on HD is higher than that of the general population of the same area. Apart from female sex, the traditional risk factors associated with gallstones in the non-uraemic general population appear not to play a significant role in gallstone formation in HD patients. Estrogen use in females, presence of diabetes mellitus and smoking in males, have insignificantly raised the risk for gallstones in these patients. Changes in serum calcium appear to play a role. Our results suggest that other factors inherent to kidney pathology may contribute to this high percentage of gallstones in CRF patients on haemodialysis

Abdominal Ultrasonography Findings in Patients with Spinal Cord Injury in Korea

This is a retrospective study of 500 patients with spinal cord injury who underwent abdominal ultrasonography as a routine screening test from 2000 to 2003. We analyzed the results according to the different abdominal organ systems. Among the 500 cases, 226 (45.2%) showed abnormal findings. 98 cases of abnormal findings in the liver included 75 of fatty liver and 13 of mass. The 88 cases of abnormal findings in the bladder included 56 of bladder wall thickening, 14 of cystitis and 10 of urinary stone. The 35 cases of abnormal findings in the kidney included 19 of renal cyst and 6 of pelvic dilatation. The 35 cases with gallbladder abnormalities included 19 with gallstones and 11 with biliary sludge. Excluding the cases with bladder wall thickening, there were still 170 cases with abnormal ultrasonographic findings. Abdominal sonography seems to be a useful tool in detecting hidden intraabdominal pathologies in patients with spinal cord injury.

Congenital absence of gallbladder

Clinical applications of applied physiology are essential both in teaching as well as in the meaningful clinical interpretation of the disease. Congenital absence of gallbladder [CAGB] is an extremely rare anomaly. This case is of a 20-year-old student, presented with right upper quadrant abdominal pain. The absence of the gallbladder was diagnosed on ultrasonography and computerized tomography [CT] scan of abdomen

Ultrasonographic evaluation of gallbladder volume in diabetics.

AIMS AND OBJECTIVE: Ultrasonographic determination of gallbladder volume in diabetics [both type I and type 2], it's comparison with a control group, and correlation of gallbladder volume in diabetics with parameters such as age, sex, body mass index, parity, hyperlipidaemia, and autonomic neuropathy. MATERIALS AND METHOD: Ninety one cases of diabetes mellitus and 40 healthy controls were recruited for the study. A detailed history and physical examination were recorded. Laboratory investigations done were--fasting and postprandial blood sugar, glycosylated haemoglobin, microalbuminuria, and serum lipid profile. Autonomic neuropathy was determined by using simple non-invasive bedside tests. Fasting gallbladder volume was measured by ultrasonography (calculated by ellipsoid formula). RESULTS: The mean fasting gallbladder volume was 18.20 +/- 2.54 ml in type I diabetics and 25.87 +/- 13.90 ml in type 2 diabetics, with a minimum value of 9.30 ml and maximum value of 88 ml. When type 2 diabetics were subgrouped according to the presence of autonomic neuropathy, higher gallbladder volumes were seen in patients with autonomic neuropathy. CONCLUSIONS: Cholecystomegaly, to a significant degree, was found in type 2 diabetics in the present study. It was significantly correlated with age, body mass index, and the severity of autonomic neuropathy. In male type 2 diabetics, gallbladder volume was significantly correlated with LDL cholesterol levels. In female type 2 diabetics, gallbladder volume was significantly correlated with waist-hip ratio. Gallbladder volume also had significant correlation with proliferative diabetic retinopathy, but not with glycaemic control, microalbuminuria, hypertension, or the duration of diabetes.

Ultrasonographic studies of gallbladder during neonatal sepsis

Neonatal infection is a major cause of morbidity and mortality in neonatal intensive care unit. A few data regarding the gallbladder [GB] manifestations during neonatal infection are known. Is to evaluate the ultrasonographic changes in gallbladder during sepsis, in order to add some markers to the clinical sepsis score. A total of 35 newborn infants with sepsis were examined, the findings were compared to 6 normal neonates. The infection group was further subdivided into two groups according to the intake of enteral feeding. Inclusion criteria included clinical, hematological and bacterial evidence of sepsis. Exclusion criteria included cholestasis due to other causes, perinatal asphyxia, VLBW and congenital anomalies. All cases were subjected to full history taking, physical examination; including estimation of gestational age, Apgar score and managed according to the routine and individual need. Laboratory investigation included; CBC, blood gases and electrolytes, blood glucose, and liver function tests, including total and direct bilirubin. Gallbladder ultrasonographic studies were done after 4 to six hours of fasting then at l5 minutes, 30 minutes. and 90 minutes after feeding to the enteral group. The results of this study showed a significant increase in the mean values of leukocytic count, direct serum bilirubin, P <0.001, there was also significant decrease in the I/T ratio and platelets. There was significant increase in the CRP. Blood cultures were positive among the septic group. There was significant increase in the size of the gall bladder among septic group compared to the normal cases, P<0.001. The enlargement was correlated with the severity of infection, serum bilirubin, gestational age, birth weight and postnatal age among the septic group. There was significant increase in the thickness of the wall of gall bladder of the septic group than the normal infants p<0.01. Sludge was detected in 31.4% of cases, stone was found in two cases. There was one case that showed perforation and biliary peritonitis. Contractility index [CI] was significantly reduced among the septic group than the control group. Cholecystitis was diagnosed among 42.9% of cases. We could demonstrate a significant increase the GB size among the NPO group than the enteral group and significant decrease in the CI. There was no significant difference in the GB wall thickness and CBD size between the enteral and NPO group. Cholecystitis is not uncommon among septic newborn infants. A target therapy to cholestasis, cholecystitis among septic newborn is highly recommended. Cholecystitis should not be overlooked when evaluating newborn infant with septicemia

Changes in gallbladder motility in gastrectomized patients

OBJECTIVES: Gastric resection may predispose gallstone formation. However, the mechanism has not been clearly understood. To evaluate the relationship between gastric resection and gallstone formation, we compared gallbladder(GB) motility in gastrectomized patients and control subjects. METHODS: We compared the GB volume and ejection fraction of the 46 gastrectomized patients with 37 healthy controls using real time ultrasonography. RESULTS: GB volume increased significantly in the gastrectomized group in fasting (30.2 13.9 ml). The GB volume after a fatty meal was greater in the gastrectomized group (12.6 6.4 ml) than in the control group (4.3 3.3 ml) (p +ADw- 0.01). A significant reduction of ejection fraction was found in gastrectomized patients (56.9 13.0+ACU-) in comparison with the control group (75.5 16.1+ACU-) (p +ADw- 0.01). The GB ejection fraction had a poor correlation to the postoperative period (r +AD0- 0.232). CONCLUSION: A gastrectomy appears to be a risk factor of GB dysmotility, which may play a major role in gallstone formation in gastrectomized patients.

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.