Prospective observational study on cholelithiasis in patients with carcinoma gall bladder in a tertiary referral hospital of Eastern India

Context: Gallbladder carcinoma (GBCA) is the fifth most common types of gastrointestinal malignancy and is the most common malignancy of the biliary tract. Cholelithiasis, gallbladder polyps, porcelain gall, and choledochal cysts are common known associations with GBCA. Because of the better understanding of the etiopathogenesis, the traditional nihilistic attitude toward the prognosis has, over the years, given way to greater interest and hope for treating the disease. Long-term survival has been reported in patients with resectable lesions in the hands of expert hepatobiliary surgeons. Objective: This prospective observational study was conducted at a tertiary referral hospital of Eastern India on patients with the diagnosis of GBCA. The main objective was to assess the incidence of gallstones in patients with GBCA, and the relationship, if any, between the size and number of stones and GBCA in our patient cohort. Materials and Methods: This prospective observational study was conducted, over a period of 2 years, at a tertiary referral hospital of Eastern India which caters to patients from all the neighboring districts. A total of 54 patients with the diagnosis of GBCA were included in the study. Data on their demographic and clinical profile, the incidence of associated gallstones, their size (<3 or ≥3cm), and number (solitary or multiple) were collected. Known predisposing factors of GBCA, if any, in those presenting without stones were noted. Results: GBCA was found to afflict females 2.4 times as frequently as males. Patients, irrespective of their sex, were mostly in their sixth decade. Approximately three-fourth of the cases had associated cholelithiasis. The number of stones had no correlation with the disease. However, contrary to available published data, stones <3 cm were significantly more common in our study cohort. Conclusion: The results of this study reaffirm that cholelithiasis is a strong predisposing factor for GBCA and females with gallstones in their sixth decade, are more at risk. Although number of stones was not found to be an independent risk factor, patients with stones <3 cm (mostly multiple) were found to be more at risk in our study

Pre-operative Prediction of Difficult Laparoscopic Cholecystectomy.

Laparoscopic cholecystectomy is the gold standard for the symptomatic gall stone disease. Sometime conversion to an open procedure may be necessary due to some difficulties encounter during laparoscopic cholecystectomy. The aim of this study is to determine whether variability of some of pre-defined pre-operative factors may have some bearing of the degree of difficulties that may be encounter during laparoscopic cholecystectomy. Seven parameters Age, Sex, BMI, ASA class, Hypertension, Diabetes and Previous Abdominal Surgery were studied in 112 patients in our department of Surgery, I.P.G.M.E&R and S.S.K.M. Hospital, Kolkata. Univariate analysis was performed using the chi-squared test to determine the factors that were associated with difficult LC, and odds ratios and their 95% confidence intervals were calculated. In 25(22.32%) patients pre-operative difficulties were encountered and out of these 6(5.35%) required conversion to open procedure. ASA class (OR 6.81, 95%CI 2.386-19.438, p <0.001), Hypertension (OR 7.76, 95%CI 2.651-22.706, p <0.001) and Diabetes mellitus (OR 4.26, 95%CI 1.2371-14.692, p 0.025) were found to be statistically significant predictor of difficult laparoscopic cholecystectomy .However, age (p 0.247), male sex (p 1.00), BMI (p 0.161) and past abdominal surgery (p 0.115) were not found to be statistically significant variables. Difficult laparoscopic cholecystectomy can be predicted pre-operatively and that may help in proper pre-operative planning and counseling to reduce overall complications and morbidity.

Hydrocele of the canal of Nuck.

Hydrocele of the canal of Nuck is an uncomon and infrequently reported finding in women. A 24-year-old female presented with a painless left groin swelling which was soft, cystic, non-tender with 7.5 cm x 5 cm in measurement. It was more prominent in standing. Ultrasonography revealed an encysted echofree lesion in the left inguinal canal. On surgery, a cyst was found containing clear fluid in the inguinal canal which was dissected out and wound was closed in layers. The patient is doing well till date. Here one such case with diagnosis of hydrocele of the canal of Nuck is reported.

Perforation of Meckel's diverticulum by roundworm.

An 11-month-old girl child presented with distension of abdomen, constipation, vomiting and fever. X-ray of the abdomen suggested intestinal obstruction. Exploration revealed the distal ileum to be kinked around a band running from the tip of a congested Meckel's diverticulum to the lateral pelvic wall. A small perforation was noticed at the tip of the diverticulum and a live roundworm was found lying free in the peritoneal cavity. The diverticulum along with a segment of adjoining bowel was resected and end-to-end anastomosis done. The diverticulum had a wide lumen and showed no heterotopic tissue on subsequent examination.

Gigantic post-traumatic pseudocyst of sigmoid mesentery.

A 29-year-old man presented with dull abdominal pain and a lump occupying almost the entire abdomen, four months after a fall from a height. Ultrasonography revealed a cystic lesion with debris occupying almost the entire abdomen. Diagnostic tap revealed brownish fluid. Exploration revealed a huge thick-walled cyst of the sigmoid mesocolon, which could be enucleated out entirely. Histology suggested it to be a false cyst.