Courvoisier's law revisited

According to Courvoisier's law; if gallbladder is palpable in a jaundiced patient, it is unlikely to be due to gallstones, because stones would have given rise to chronic inflammation and subsequently fibrosis of gallbladder therefore, rendering it incapable of dilatation. Conversely, the causes other than stone [principally tumours], would result in the distension of gallbladder, felt on abdominal palpation. However, in Courvoisier study of 109 cases of dilatation of gallbladder, 17 were due to impacted stones. Therefore, Courvoisier concluded that dilatation of gallbladder was rare with stones obstructing the common bile duct. Despite this fact it is always assumed that the palpable gallbladder is due to malignancy [pancreatic or periampullary etc.]. Here, we report a rare case of palpable gallbladder in a jaundiced patient due to multiple cholelithiasis and a large choledocholithiasis causing obstruction of CBD

Early laparoscopic chdecystectomy

To assess the clinical outcome of laparoscopic Cholecystectomy for management of acute cholecystitis and to evaluate its safety, frequency of complications. Observational study. Surgical Units II and III of Chandka Medical College Hospital Larkana. From 01.09.2003 up to 31.12. 2007. A total of 100 consecutive cases of, acute cholecystitis confirmed subsequently by abdominal ultrasound scanning, who were admitted for early laparoscopic Cholecystectomy. There was female preponderance with male to Female ratio of 1:4.5. Mean age was 45.75, SD 11.99, and most of patients were received with in 24 hours from the onset of symptoms. In 51 patients ultrasound reveals Edematous GB in 24 [24%], Empyma 8[8%], Contracted 10[10%], Perforated 5[5%] and Gangrenous GB in 4[4%] while 49[49%] have acute cholecystitis with cholelithiasis. The conversion rate was 6%; The minimum time taken during the procedure was 50 minutes. No mortality was reported in this series. Emergency / early Cholecystectomy is reliable and safe modality cost effective, and timely surgery with modern conception in the management of acute cholecystitis, because of accelerated recovery, negligible wound infection or related complication, and less postoperative pain. So Lap Chole should be preferred technique now days for the treatment of acute cholecystitis at our Institute