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2.
Rev. argent. cir ; 113(1): 125-130, abr. 2021. graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1288183

ABSTRACT

RESUMEN La vesícula izquierda (VI) es una rara anomalía de la vía biliar que, cuando enferma, no suele dar sín tomas diferentes de aquella normoposicionada, haciendo infrecuente su diagnóstico preoperatorio. Presentamos el caso de una colecistitis aguda en un paciente con VI, resuelto en forma segura por vía laparoscópica. Un paciente ingresa por un cuadro típico de colecistitis aguda. Como hallazgo in traoperatorio se constata una vesícula biliar inflamada, ubicada en posición siniestra. Se modificó la ubicación de los puertos de trabajo y se realizó colangiografía transvesicular por punción, antes de iniciar la disección del hilio vesicular. Luego de identificar el conducto cístico, se realizó colangiografía transcística que confirmó la anatomía de la vía biliar completa y expedita. Se completó la colecistec tomía laparoscópica en forma segura. El hallazgo de una VI obliga al cirujano a cambiar la técnica de una colecistectomía laparoscópica. Esta anomalía incrementa el riesgo de lesiones de la vía biliar. La disección cuidadosa del hilio vesicular logrando una visión crítica de seguridad y el uso de colangiogra fía intraoperatoria son de extrema importancia para una colecistectomía segura.


ABSTRACT Left-sided gallbladder (LSGB) is a rare bile duct abnormality, usually found during a cholecystectomy. Symptoms usually do not differ from those of a normally positioned gallbladder, making the preoperative diagnosis extremely uncommon. We report the case of an acute cholecystitis in a patient whit LSGB, safely managed with laparoscopic surgery. A 24-year-old male patient was admitted to our institution with clinical and radiological signs of acute cholecystitis. The intraoperative finding of an acute cholecystitis in a LSGB made us modify ports positioning and a cholangiograhy was done by direct puncture of the gallbladder before hilum dissection. After the cystic duct was identified, a transcystic cholangiography was performed which confirmed a complete and clear bile duct anatomy and laparoscopic cholecystectomy was safely completed. The intraoperative finding of a LSGB makes the surgeon change some aspects of the usual technique to perform a safe cholecystectomy as LSGB significantly increases the risk of common bile duct injuries. Meticulous dissection of the gallbladder hilum to achieve a critical view of safety and the systematic use of intraoperative cholangiography are extremely important to perform a safe laparoscopic cholecystectomy.


Subject(s)
Humans , Male , Adult , Cholecystitis, Acute/diagnostic imaging , Gallbladder , Cholangiography , Monitoring, Intraoperative , Cholecystectomy, Laparoscopic , Laparoscopy
3.
Rev. argent. cir ; 113(1): 121-124, abr. 2021. graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1288182

ABSTRACT

RESUMEN La neoplasia papilar intracolecística con carcinoma mucinoso invasor y células en anillo de sello es una variedad de cáncer de vesícula, una patología agresiva y con mal pronóstico, la cual puede presentarse en forma similar a una colecistitis y, a pesar del tratamiento operatorio y quimioterapia posterior, la supervivencia y pronóstico son peores en relación con los otros cánceres de vesícula. Este artículo tie ne por objetivo describir un tipo histológico muy específico, de baja frecuencia, de cáncer de vesícula y el tratamiento realizado.


ABSTRACT Intracholecystic papillary neoplasm with invasive mucinous adenocarcinoma and signet ring cells is a rare, aggressive variety of gallbladder cancer, with symptoms mimicking cholecystitis. Survival and prognosis are worse that other types of gallbladder cancer despite surgery and chemotherapy. The aim of this article is to describe a case of a rare gallbladder cancer with specific histology and the treatment performed


Subject(s)
Humans , Male , Aged , Gallbladder Neoplasms , Pathology , Survival , Therapeutics , Grief , Cells , Baja , Blister , Drug Therapy , Gallbladder , Histology , Neoplasms
4.
Rev. cuba. invest. bioméd ; 40(1): e839, ene.-mar. 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1289452

ABSTRACT

Introducción: La litogénesis biliar, proceso de sobresaturación de colesterol en la bilis vesicular, es prevenible. Objetivo: Describir las nuevas evidencias biomoleculares de la litogénesis biliar de colesterol como base de la futura terapia preventiva de la litiasis vesicular. Método: Se realizó una revisión sistemática y crítica de las evidencias de impacto sobre la litogénesis biliar. Se consultaron artículos publicados entre 2015-2020 en las bases de datos PubMed, Medline, SciELO, LILACS y Elsevier. Resultados: Se recuperaron evidencias actuales de los mecanismos biomoleculares relacionados con las futuras terapias preventivas de la litiasis vesicular, propuestos como fundamentos teóricos. Conclusiones: La descripción actualizada de la litogénesis biliar de colesterol, con los nuevos conceptos biomoleculares incorporados, aporta a su comprensión el papel de los genes de receptores nucleares, la intervención de estos últimos y de los transportadores de la secreción biliar. Dirigida a médicos generales, cirujanos, gastroenterólogos y fisiólogos, la descripción actualizada de La litogénesis biliar impacta como nuevo paradigma con los conceptos biomoleculares que intervienen en pro de su prevención(AU)


Introduction: Biliary lithogenesis is a preventable process of cholesterol supersaturation in gallbladder bile. Objective: Describe the new biomolecular evidence of biliary cholesterol lithogenesis serving as a basis for future preventive therapy for gallbladder lithiasis. Methods: A systematic critical review was conducted of impact evidence about biliary lithogenesis. The papers consulted were published in the databases PubMed, Medline, SciELO, LILACS and Elsevier from 2015 to 2020. Results: Current evidence was retrieved of biomolecular mechanisms proposed as theoretical foundations for future preventive therapies for gallbladder lithiasis. Conclusions: Intended for general practitioners, surgeons, gastroenterologists and physiologists, the updated description of biliary lithogenesis including the role of nuclear receptors, biliary lipid transporters and the biological value of enterohepatic circulation in the integrity and functioning of the hepatobiliary system as regulators of the cholesterol mechanism, makes an impact as a new paradigm with the biomolecular concepts involved in biliary lithogenesis prevention(AU)


Subject(s)
Humans , Biological Products , Cholesterol/metabolism , Enterohepatic Circulation , Gastroenterologists , Gallbladder , Urinary Bladder Calculi/prevention & control
5.
Clin. biomed. res ; 41(4): 368-370, 20210000.
Article in Portuguese | LILACS | ID: biblio-1349410

ABSTRACT

A heterotopia pancreática é definida como a presença de tecido pancreático em localização topográfica anômala. Essa patologia pode acometer variadas estruturas da cavidade abdominal, mas raramente manifesta-se na vesícula biliar. Até o momento, menos de 40 casos de heterotopia pancreática em vesícula biliar foram relatados na literatura médica. Apresentamos um caso de uma mulher de 25 anos, que realizou uma colecistectomia videolaparoscópica por colelitíase, com exame anatomopatológico que identificou uma heterotopia pancreática. Apesar de rara, a doença deve ser considerada em pacientes com sintomatologia de doenças da via biliar e de doenças pancreáticas e sem diagnóstico após uma investigação de rotina, tendo em vista que o tecido pancreático ectópico está sujeito às mesmas alterações patológicas, manifestações clínicas e complicações encontradas no próprio pâncreas. (AU)


Heterotopic pancreas is defined as the presence of pancreatic tissue at an anomalous location. This condition may affect multiple structures in the abdominal cavity but rarely appears in the gallbladder. To date, fewer than 40 cases of heterotopic pancreas in the gallbladder have been reported in the medical literature. We present a case of a 25 year-old woman who underwent a laparoscopic cholecystectomy for cholelithiasis, with a pathology test that detected heterotopic pancreas. Despite its rarity, this disease must be considered in cases of corresponding symptoms without a diagnosis after a routine evaluation, considering that ectopic pancreatic tissue is exposed to the same pathological alterations, clinical manifestations, and complications found in the pancreas. (AU)


Subject(s)
Humans , Female , Adult , Pancreas , Choristoma/diagnostic imaging , Gallbladder , Choristoma/physiopathology , Cholecystectomy, Laparoscopic
6.
Autops. Case Rep ; 11: e2021248, 2021. graf
Article in English | LILACS | ID: biblio-1153175

ABSTRACT

Metastatic gallbladder carcinoma to the ovaries is occasional but a recognized entity. It can mimic, clinical and morphologically, a primary ovarian tumor, challenging the diagnosis. We present the case of a patient with a lump in the hypogastrium extending into the right iliac fossa and was found to have abdominopelvic cystic lesion with enhancing solid components and multiple sub-centimetric and ill-defined abdominal lymph nodes. Also, subpleural and parenchymal nodules in the lungs were present. She subsequently underwent a laparotomy. Cholecystectomy was also done due to pre-existing symptomatic biliary lithiasis. The histologic report described the ovarian involvement as metastases from a gallbladder carcinoma. The presentation of ovarian metastases can challenge the diagnosis. Hence, careful evaluation of the digestive tract and judicious use of immunohistochemistry should be considered in patients presenting with ovarian masses.


Subject(s)
Humans , Female , Middle Aged , Ovarian Neoplasms/pathology , Carcinoma , Gallbladder/abnormalities , Immunohistochemistry , Neoplasm Metastasis
7.
Autops. Case Rep ; 11: e2020232, 2021. graf
Article in English | LILACS | ID: biblio-1153174

ABSTRACT

Acute hemorrhagic cholecystitis is a rare, life-threatening condition that can be further complicated by perforation of the gallbladder. We describe a patient with clinical and radiologic findings of acute cholecystitis with a gallbladder rupture and massive intra-abdominal bleeding. Our patient is a 67-year-old male who presented with an ischemic stroke and was treated with early tissue plasminogen activator. His hospital course was complicated by a fall requiring posterior spinal fusion surgery. He recovered well, but several days later developed subxiphoid and right upper quadrant pain and an episode of hemobilia and melena. A computed tomography scan revealed an inflamed, distended gallbladder with indistinct margins and a large hematoma in the gallbladder fossa extending to the right paracolic gutter. The patient also developed hemodynamic instability concerning for hemorrhagic shock. He underwent an emergent laparoscopic converted to open subtotal fenestrating cholecystectomy with abdominal washout for management of his acute hemorrhagic cholecystitis with massive intra-abdominal hemorrhage. Prompt recognition of this lethal condition in high-risk patients is crucial for optimizing patient care.


Subject(s)
Humans , Male , Aged , Biliary Tract Surgical Procedures , Cholecystitis, Acute/complications , Gallbladder/injuries , Postoperative Complications , Stroke/surgery
9.
Rev. colomb. gastroenterol ; 35(4): 414-420, dic. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1156323

ABSTRACT

Resumen Introducción: los pólipos de vesícula biliar, benignos y malignos, en la mayoría de pacientes tienen un diagnóstico generalmente incidental; a través de estudios de imágenes, que no se pueden distinguir con precisión según su grado de malignidad. Objetivo: determinar los factores de riesgo para la malignidad de los pólipos vesiculares en dos hospitales públicos peruanos. Metodología: estudio de cohorte retrospectiva, de datos secundarios, en colecistectomizados del 2004 al 2012 en un hospital de Lima y otro de Callao. Se definió como pólipo maligno según el tipo histopatológico de adenocarcinoma. Se obtuvieron los riesgos relativos y sus intervalos de confianza del 95 % (IC 95 %). Además, mediante curvas ROC (característica operativa del receptor), se obtuvieron la sensibilidad y especificidad según el tamaño de pólipo. Resultados: de las 368 biopsias, 26 (7 %) fueron adenocarcinomas. La mediana del tamaño de los pólipos fue de 4 mm (rango: 1-65 mm), 176 (51 %) tuvieron múltiples pólipos y 85 (23 %) tuvieron litiasis biliar asociada. En el análisis multivariado, se incrementó el riesgo de malignidad por cada milímetro del tamaño del pólipo en 26 % (IC 95 %:14 %-40 %, valor p < 0,001) y del tamaño de la pared vesicular en 182 % (IC 95 %:46 %-445 %, valor p: 0,002), ajustados por la edad del paciente, la litiasis y el tamaño vesicular. Para un tamaño de 6 mm se tuvo una sensibilidad de 81 % y especificidad del 85 %. Conclusión: se concluye que el tamaño del pólipo y el grosor de la pared vesicular estuvieron asociados con la malignidad de pólipos vesiculares.


Abstract Introduction: In most patients, gallbladder polyps, both benign and malignant, are usually an incidental finding. However, imaging studies cannot accurately establish their degree of malignancy. Objective: To determine the risk factors for gallbladder polyp malignancy in two Peruvian public hospitals. Methodology: Retrospective cohort study conducted on secondary data from patients who underwent cholecystectomy between 2004 and 2012 in Lima and another in Callao, Peru. The malignancy of the polyp was established according to the histopathological type of adenocarcinoma. Relative risks and their 95% confidence intervals (95%CI) were obtained. Moreover, ROC curves were used to determine sensitivity and specificity according to the size of the polyp. Results: Of 368 biopsies, 26 (7%) were adenocarcinomas. The median size of the polyps was 4mm (range: 1-65mm). 176 patients (51%) had multiple polyps, and 85 (23%) had associated gallstones. Multivariate analysis showed that the risk of malignancy increased by 26% (95%CI:14-40%, p-value:<0.001) per millimeter of polyp size and by 182% (95%CI:46-445%, p-value=0.002) based on vesicular wall size, adjusted for patient age, lithiasis and vesicular size. For a size of 6mm, sensitivity was 81%, and specificity was 85%. Conclusion: The size of the polyp and the thickness of the vesicular wall are associated with the malignancy of vesicular polyps.


Subject(s)
Humans , Male , Female , Polyps , Adenocarcinoma , Risk Factors , Gallbladder , Hospitals, Public , Neoplasms
10.
Medisan ; 24(6) ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1143271

ABSTRACT

Se describe el caso clínico de una paciente de 95 años de edad, quien acudió al Cuerpo de Guardia del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba por presentar dolor abdominal difuso, de comienzo súbito con 48 horas de evolución, acompañado de náuseas y vómitos de escasa cuantía y de coloración oscura, así como ligera distención abdominal, sin expulsión de heces ni gases. Se decidió su ingreso para tratamiento quirúrgico urgente, con el diagnóstico presuntivo de oclusión intestinal. Durante la cirugía se encontró la vesícula distendida con su pedículo torcido. Se realizó colecistectomía típica. La paciente evolucionó satisfactoriamente y no presentó complicaciones posoperatorias.


The case report of a 95 years patient is described, she went to the emergency department of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba due to a diffuse abdominal pain, of sudden beginning with 48 hours of clinical course, accompanied by nauseas and vomits of scarce quantity and dark color, as well as slight abdominal distention, without expulsion of stools neither gases. Her admission was decided for emergency surgical treatment, with the presumptive diagnosis of intestinal occlusion. During the surgery the distended gallbladder with bent pedicle was found. A typical cholecystectomy was carried out. The patient had a favorable clinical course and she didn't present postoperative complications.


Subject(s)
Cholecystectomy , Gallbladder/surgery , Torsion Abnormality , Middle Aged
11.
Int. j. morphol ; 38(4): 869-875, Aug. 2020. graf
Article in English | LILACS | ID: biblio-1124868

ABSTRACT

In the current study, the histological structure of the gallbladder of Alburnus tarichi (Güldenstädt, 1814) was investigated. Hematoxylin and eosin were used to stain the histological sections for routine examinations, in addition to using periodic acid Schiff (PAS) for the neutral mucins, aldehyde fuchsin (AF) for the sulphated mucins, and Alcian blue (AB; pH: 2.5) for the acidic mucins. In addition, proliferating cell nuclear antigen (PCNA) immune-staining was performed for the detection of dividing cells among the epithelium. The gallbladder of A. tarichi was composed of mucosa, muscularis, and serosa or adventitia layers. The mucosa covering the wavy pleomorphic folds was made up of tall columnar epithelium and a lamina propria. The apical surface of the epithelial cells was lined by continuous short microvilli. On the epithelium, the luminal surface was remarkably stained with PAS, AF, and AB. Slight to moderate staining was observed on the epithelial cells in the apical zone with PAS. The cytoplasm of epithelial cells were stained in a slight manner with AF. No goblet cells were observed among the epithelium. According to the PCNA immune-staining, some epithelial cells were observed to proliferate. The lamina propria consisted of loose connective tissue that contained fibrocytes, collagen and elastic fibers, capillaries, and small blood vessels. The muscularis layer displayed muscle fibers that were circular, smooth, and surrounded by collagen fibers. The subserosal and serosal or adventitial layers had typical morphology to those of other fish and vertebrates.


En este estudio, se investigó la estructura histológica de la vesícula biliar de Alburnus tarichi (Güldenstädt, 1814). Las secciones histológicas se tiñeron con Hematoxilina-Eosina para los exámenes de rutina, además de usar el ácido periódico de Schiff (PAS) para las mucinas neutras, aldehído fucsina (FA) para las mucinas sulfatadas y azul alcián (AB; pH: 2,5) para las mucinas ácidas. Además, se realizó una tinción inmune de antígeno nuclear de células proliferativas (PCNA) para la detección de células en división entre el epitelio. La vesícula biliar de A. tarichi estaba compuesta de capas, mucosa, muscular y serosa o adventicia. La mucosa que cubría los pliegues pleomórficos ondulados estaba formada por un epitelio columnar alto y una lámina propia. Se observó una superficie apical de las células epiteliales revestida por microvellosidades cortas y continuas. En el epitelio se observó una tinción importante de la superficie luminal teñida con PAS, FA y AB. Se observó una tinción leve a moderada en las células epiteliales en la zona apical con PAS. El citoplasma de las células epiteliales se tiñó ligeramente con FA. No se observaron células caliciformes entre el epitelio. Según la tinción de PCNA, se observó que proliferaban algunas células epiteliales. La lámina propia consistía en tejido conectivo laxo que contenía fibrocitos, colágeno y fibras elásticas, capilares y pequeños vasos sanguíneos. La capa muscular mostraba fibras musculares circulares, lisas y rodeadas de fibras de colágeno. Las capas subserosas y serosas o adventicias tenían una morfología típica a la de otros peces y vertebrados.


Subject(s)
Animals , Cyprinidae/anatomy & histology , Gallbladder/anatomy & histology , Proliferating Cell Nuclear Antigen
12.
Rev. cir. (Impr.) ; 72(3): 262-266, jun. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1115553

ABSTRACT

Resumen El cáncer de vesícula es infrecuente a nivel mundial, a diferencia de su alta incidencia en Chile. Su pronóstico es malo en general, y dependerá de su forma de presentación, siendo mejor en los casos diagnosticados después de una colecistectomía laparoscópica por patología benigna. La reintervención, que incluye la resección hepática y linfadenectomía, es el pilar de la terapia curativa en esta neoplasia. Presentamos la descripción de la técnica quirúrgica realizada en los pacientes con cáncer de vesícula de diagnóstico incidental, en el Servicio de Cirugía de Clínica Alemana de Santiago y en el Hospital de la Fuerza Aérea de Chile. El abordaje laparoscópico representa una alternativa quirúrgica válida en el tratamiento de pacientes con cáncer de vesícula biliar diagnosticados después de la colecistectomía. La estandarización de la técnica debiera contribuir a su mayor empleo y a la obtención de buenos resultados desde un punto de vista oncológico.


Gallbladder cancer is considered an infrequent disease but in Chile has a higher incidence. Prognostic is considered dismal except in those patients in whom the diagnosis is performed after the cholecystectomy specimen study. Reoperation with gallbladder bed resection and lymphadenectomy is considered the treatment in patients with incidental cases. We show the way this operation is performed in Clinica Alemana of Santiago and in the Air Force Hospital. The laparoscopic approach is an alternative to those patients in whom the diagnosis was done after the cholecystectomy. Laparoscopy allows to accomplish same objectives and to obtain identical results that the open approach. The technical standardization should contribute to spread its employment and to improve the results.


Subject(s)
Humans , Biliary Tract Surgical Procedures/methods , Gallbladder/surgery , Gallbladder Neoplasms/surgery , Lymph Node Excision/methods , Biliary Tract Surgical Procedures/adverse effects , Laparoscopy , Disease Management , Incidental Findings , Lymph Node Excision/standards
13.
Arq. bras. med. vet. zootec. (Online) ; 72(3): 1063-1066, May-June, 2020. ilus
Article in Portuguese | ID: biblio-1129774

ABSTRACT

Carcinoid is a neoplasia that arises from dispersed cells of the neuroendocrine system. This tumor is uncommon in animals, and its occurrence in the gallbladder is rare. A male Basset Hound dog's corpse was taken to the Univerdade Federal de Minas Gerais to be analyzed by the Veterinary Pathology sector, without a description of its previous history. Necropsy revealed the presence of pale oral, ocular and penile mucous membranes. The gallbladder had a thickened wall and a dilated lumen, which was filled with dark and lumpy bile. Its mucosa had a whitish-red nodule, with solid and friable areas. Microscopically, there was a focal neoplastic proliferation, which wasn't encapsulated and had imprecise limits, which cells were distributed in a solid pattern and separated by a delicate fibrovascular stroma. The neoplastic cells presented oval or round shaped nucleus, which had a chromatin predominantly loose, and one or two nucleoli. Their cytoplasm was moderately abundant, and in most of the cells it was eosinophilic, granular, and had well-defined limits. Using the Grimelius coloration, neoplastic cells' cytoplasmic granules stained brownish or black, confirming the neuroendocrine origin of the neoplasia. Based on the macroscopic and microscopic findings, the diagnosis of a gallbladder carcinoid was established.(AU)


Subject(s)
Animals , Male , Dogs , Carcinoid Tumor/veterinary , Carcinoma, Neuroendocrine/veterinary , Gallbladder/pathology , Gallbladder Neoplasms/veterinary
14.
Rev. cuba. med. mil ; 49(2): e515, abr.-jun. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1138990

ABSTRACT

Introducción: La colecistectomía videolaparoscópica es el proceder más idóneo para tratar la litiasis vesicular y sus complicaciones, pero existen factores epidemiológicos que pueden propiciar la conversión. Objetivo: Determinar los factores epidemiológicos que incidieron en la conversión de la colecistectomía videolaparoscópica. Métodos: Se realizó un estudio de tipo descriptivo y retrospectivo en el Hospital Militar "Octavio de la Concepción y de la Pedraja", desde enero de 2010 hasta mayo de 2019. Fueron estudiados 64 pacientes intervenidos de forma electiva o de urgencia, que fueron convertidos de mínimo acceso a vía convencional. Resultados: Se evidenció mayor número de conversiones urgencias, a predominio de hombres, con rango de edad entre 41 y 55 años. En la cirugía electiva sobresalió el sexo femenino, del mismo grupo etario. La conversión fue más habitual en los pacientes sobrepeso. La litiasis vesicular sintomática (cólico biliar) fue la condición más encontrada como antecedente. La diabetes mellitus fue la enfermedad crónica no trasmisible más asociada a la conversión. Conclusiones: Fue más frecuente la conversión en el grupo de edad entre 41 a 55 años, en pacientes del sexo masculino, sobrepeso, asociado a cólicos biliares y diabetes mellitus(AU)


Introduction: Videolaparoscopic cholecystectomy is the most suitable procedure to treat gallbladder lithiasis and its complications, but there are epidemiological factors that can promote conversion. Objective: To determine the epidemiological factors that influenced the conversion of videolaparoscopic cholecystectomy. Methods: A descriptive and retrospective study was carried out at the Hospital Militar "Octavio de la Concepción y de la Pedraja", from January 2010 to May 2019. 64 patients underwent elective or emergency surgery, who were converted with minimal access to conventional. Results: A greater number of conversions from emergency was evident, predominantly in men, with an age range between 41 and 55 years. In elective surgery, the female sex, from the same age group, stood out. Conversion was more common in overweight patients. Symptomatic gallbladder lithiasis (biliary colic) was the most commonly found condition as an antecedent. Diabetes mellitus was the chronic non-communicable disease most associated with conversion. Conclusions: Conversion was more frequent in the age group between 41 to 55 years, in male patients, overweight, associated with biliary colic and diabetes mellitus(AU)


Subject(s)
Humans , Male , Female , General Surgery , Cholecystectomy , Chronic Disease , Lithiasis , Overweight , Gallbladder , Retrospective Studies
15.
Rev. cuba. invest. bioméd ; 39(1): e259, ene.-mar. 2020.
Article in Spanish | LILACS, CUMED | ID: biblio-1126581

ABSTRACT

Introducción: Estudios anatomofisiológicos y biomoleculares de la vesícula biliar han permitido redefinir su función no solo como reservorio de la secreción biliar, sino como protectora intestinal, concepto que se fundamenta en su capacidad de control de la bioactividad y la toxicología de los ácidos biliares, el metabolismo del colesterol, los fosfolípidos y otros componentes de la secreción hepatobiliar. Objetivo: Describir las actualidades de la funcionabilidad de la vesícula biliar como reservorio y protectora del tracto digestivo dirigido a que cirujanos generales, gastroenterólogos, clínicos y fisiólogos amplíen sus conocimientos sobre la función de la vesícula biliar. Métodos: Se realiza una revisión crítica de las funciones de la vesícula biliar que favorecen mantener la integridad de la pared intestinal. Conclusión: La descripción actualizada de la funcionabilidad de la vesícula biliar ofrece un resultado relevante dentro del marco conceptual en relación a su función protectora que se traduce en el mantenimiento de la integridad del epitelio y la microbiota intestinal(AU)


Introduction: Anatomic-physiological and biomolecular studies of the gallbladder have made it possible to redefine its function not only as a reservoir for bile secretion, but also as intestinal protector. This concept is supported by its capacity to control the bioactivity and toxicology of bile acids, cholesterol metabolism, phospholipids and other components of hepatobiliary secretion. Objective: Present an update on the role of the gallbladder as reservoir and protector of the digestive tract intended for general surgeons, gastroenterologists, clinicians and physiologists to broaden their knowledge about the functions of the gallbladder. Methods: A critical review was conducted of the functions of the gallbladder which facilitate maintenance of the integrity of the intestinal wall. Conclusion: The updated description of the functions of the gallbladder is a relevant contribution to the conceptual framework of its protective function, which ensures the maintenance of the integrity of the epithelium and the intestinal microbiota(AU)


Subject(s)
Humans , Gastrointestinal Microbiome , Gastroenterologists , Bile/physiology , Gastrointestinal Tract/physiology , Gallbladder/physiology
16.
Rev. cir. (Impr.) ; 72(1): 76-81, feb. 2020. tab, ilus
Article in Spanish | LILACS | ID: biblio-1092895

ABSTRACT

Resumen Introducción La lesión de la vesícula biliar secundaria a trauma abdominal cerrado constituye un evento infrecuente de perforación traumática de ella, de presentación tardía. Objetivo Revisar la literatura científica actualmente disponible y además describimos un caso. Materiales y Método Utilizando la plataforma PubMed se buscan las siguientes palabras clave: " Blunt abdominal trauma ". Se seleccionan las series con lesiones de la vesícula biliar: " Traumatic gallbladder rupture". Se seleccionan los reportes de lesiones aisladas de la vesícula biliar: " Isolated gallbladder rupture ". Se seleccionan los reportes de presentación tardía de lesiones aisladas de la vesícula biliar: " Delayed presentation of isolated gallbladder rupture ". Resultados De todas estas publicaciones se seleccionan las que a criterio de los autores son relevantes para el presente caso. Discusión La mayoría de las perforaciones de la vesícula biliar se producen en vesículas sanas de paredes delgadas distendidas por el ayuno o el consumo de alcohol. No existe una presentación clínica clásica. Los estudios imagenológicos son inespecíficos y se llega al diagnóstico definitivo durante la exploración quirúrgica. El tratamiento de esta lesión es la colecistectomía. Conclusiones El diagnóstico no es fácil, pero la resolución es relativamente simple y el pronóstico es bueno. El presente caso ilustra este tipo de lesiones en pacientes con trauma abdominal cerrado.


Introduction Gallbladder injury secondary to blunt abdominal trauma is a rare event. Aim Review the current available scientific literature and describe a case. Materials and Method Using the PubMed platform, the following keywords were searched: "Blunt abdominal trauma". Series with gallbladder lesions were selected: "Traumatic gallbladder rupture". Reports of isolated lesions of the gallbladder were selected: "Isolated gallbladder rupture". Reports of late presentation of isolated lesions of the gallbladder were selected: "Delayed presentation of isolated gallbladder rupture". Of all these publications, those that were relevant to the present case were selected according to the criteria of the authors. Case report A 20 years-old male patient suffered an abdominal trauma two weeks before presentation at our Institution. He underwent an exploratory laparotomy showing bilious content and a gallbladder perforation over the peritoneal wall as an isolated injury. Discussion Most isolated gallbladder perforations occur in healthy gallbladders with thin walls and distended because fasting or alcohol consumption. There are no classical clinical features to diagnose this specific injury and radiologic studies are nonspecific. Definitive diagnosis is often reached during surgery as it was with our patient. Recommended treatment is cholecystectomy. Conclusions This case illustrates this unique kind of gallbladder injury in patients with blunt abdominal trauma. A clear diagnosis is not easy however, the treatment is simple and prognosis is good.


Subject(s)
Humans , Male , Young Adult , Wounds, Nonpenetrating/surgery , Wounds, Nonpenetrating/complications , Wounds, Nonpenetrating/diagnosis , Cholecystectomy/methods , Gallbladder/injuries , Tomography, X-Ray Computed , Gallbladder/surgery , Abdominal Injuries/surgery , Abdominal Injuries/complications , Abdominal Injuries/diagnosis
17.
Int. j. morphol ; 38(1): 30-34, Feb. 2020. graf
Article in Spanish | LILACS | ID: biblio-1056392

ABSTRACT

Realizar un estudio anatómico in vivo con la especial y pequeña disección quirúrgica durante una colecistectomía laparoscópica sobre las variaciones de la arteria cística. Estudio prospectivo de 38 meses, en 2000 pacientes consecutivos sometidos a colecistectomía laparoscópica programada, sin signos de inflamación aguda, ni alteración que impida disección y correcta evaluación del triángulo hepatocístico. Se disecó quirúrgicamente identificándose la arteria cística y posible duplicación, eran clínicamente importantes aquellas con diámetro mayor a 1,5 mm, requerían maniobra hemostática. Se anotaron los hallazgos en planilla especial a los fines del presente estudio. En 1831 casos había arteria única en medio del triángulo hepatocístico. Hubo 169 variaciones (8,45 %). En 97 casos: doble vascularización, con una arteria en situación normal y otra ubicada lateralmente al triangulo hepatocístico. En 44 pacientes había una arteria única lateralmente al conducto cístico que no lo cruzaba nunca. En 22 casos existía una arteria cruzando el colédoco y el cístico entrando en el triángulo. En 6 oportunidades una doble arteria, una en el triángulo hepatocístico y otra lateralmente que no cruzaba el cístico ni colédoco. En una oportunidad se observó una sola arteria importante que salía directamente de la placa cística entre segmento 4 y 5, y en otro caso solo pequeñas arterias proveniente de la placa cística. Podemos dividirlas en arterias únicas o dobles, en base exclusiva a la necesidad de maniobra hemostática. Podemos decir que las variaciones estarán presentes en aproximadamente 1/12 casos y necesitará una maniobra hemostática especial en 1/20 casos.


This is an anatomical study with the special and small dissection of a laparoscopic cholecystectomy on the surgically important variations of the cystic artery. A prospective, 19-month study was conducted in 2000, including consecutive patients undergoing programmed laparoscopic cholecystectomy, without signs of acute inflammation, or alteration, that would prevent dissection and correct evaluation of the cystohepatic triangle. It was surgically dissected, identifying the main cystic artery and its possible collateral arteries. Those with a diameter greater than 1.5 mm being considered as clinically important, requiring haemostatic maneuver (clipping and / or electrocoagulation). The findings were recorded on a special form for the purposes of this study. The classic, single-artery arrangement in the middle of the cystohepatic triangle was found in 1831 cases. The variations found were 169 (8.45 %). In 97 cases there was double vascularization, with one artery in normal position and another outside the cystic duct. In 44 patients, a single artery that did not cross the cystic was observed. In 22 cases an artery outside the cystic but crossing it before the duct. In 6 cases a double artery, one in the cystohepatic triangle and another outside the triangle, did not cross the cystic or the bile duct. In one instance, a single major artery was seen emerging directly from the cystic plaque between segments four and five. These can be divided into single or double arteries, based exclusively on the need for hemostatic maneuver. Knowledge of anatomical variations of the cystic artery is important for the surgeon. The variation presents in 1 of 12 cases, and requires a special hemostatic maneuver in 1 of 20 cases.


Subject(s)
Humans , Cystic Duct/blood supply , Anatomic Variation , Gallbladder/blood supply , Gallbladder Diseases/surgery , Hepatic Artery/anatomy & histology , Prospective Studies , Cholecystectomy, Laparoscopic
18.
Article in English | WPRIM | ID: wpr-787233

ABSTRACT

Endobiliary radiofrequency ablation (RFA) is a procedure performed widely to induce locoregional tumor control by the transfer of thermal energy to the lesion and subsequent tumor necrosis. A 72-year-old male with a prior history of acute calculous cholangitis and perforated cholecystitis was admitted to the Kyungpook National University Hospital complaining of fever and nausea. He had an indwelling percutaneous transhepatic gallbladder drainage (PTGBD) catheter from the previous episode of perforated cholecystitis. An abdominal CT scan showed marked dilation of both the intrahepatic and extrahepatic bile ducts. Common bile duct cancer was confirmed histologically after an endobiliary biopsy. A surgical resection was considered to be the initial treatment option. During open surgery, multiple metastatic nodules were present in the small bowel mesentery and anterior abdominal wall. Resection of the tumor was not feasible, so endobiliary RFA was performed prior to biliary stenting. Cholecystectomy was required for the removal of the PTGBD catheter, but the surgical procedure could not be performed due to a cystic ductal invasion of the tumor. Instead, chemical ablation of the gallbladder (GB) with pure ethanol was performed to breakdown the GB mucosa. Palliative treatment for a biliary obstruction was achieved successfully using these procedures. In addition, a PTGBD catheter was removed successfully without significant side effects. As a result, an improvement in the patient's quality of life was accomplished.


Subject(s)
Abdominal Wall , Aged , Bile Ducts, Extrahepatic , Biopsy , Catheter Ablation , Catheters , Cholangiocarcinoma , Cholangiopancreatography, Endoscopic Retrograde , Cholangitis , Cholecystectomy , Cholecystitis , Common Bile Duct , Cystic Duct , Drainage , Ethanol , Fever , Gallbladder , Humans , Male , Mesentery , Mucous Membrane , Nausea , Necrosis , Palliative Care , Quality of Life , Stents , Tomography, X-Ray Computed
20.
Clin. biomed. res ; 40(2): 144-145, 2020.
Article in English | LILACS | ID: biblio-1147984

ABSTRACT

Gallbladder duplication results from a rare abnormality of embriogenesis and is twice as common in women as in men. The signs and symptoms of double gallbladder cholecystitis are the same as those of single gallbladder cholecystitis: strong pain in the epigastric region and right hypochondrium, which may irradiate to the back and be accompanied by nausea and/or vomiting, Murphy positive sign, and pain on palpation of these regions; plastron may also be present. For this reason, many cases are still diagnosed intraoperatively, making surgery difficult and increasing the possibility of biliary tract injury. We report the case of a female patient with epigastric and dorsal pain for 4 days, which worsened with the ingestion of salty and fatty foods and was accompanied by nausea and vomiting. Physical examination showed a positive Murphy sign. A complete abdominal ultrasound examination showed gallbladder duplication, both lithiasic. Magnetic resonance cholangiography confirmed the duplication of the gallbladder and cystic ducts, with a single main biliary tract and acute lithiasic cholecystitis in both gallbladders. A laparoscopic cholecystectomy of both vesicles was performed without complications, and the patient was discharged 3 days after the procedure. (AU)


Subject(s)
Humans , Female , Adolescent , Gallbladder/abnormalities , Gallbladder Diseases/surgery , Gallbladder Diseases/diagnostic imaging
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