Niveles séricos de proteína C reactiva como marcador de gravedad de colecistitis aguda litiásica: serie de casos prospectiva / Serum levels of C-reactive protein as a marker of gravity of acute cholecystitis: prospective series of cases

La colecistitis aguda (CA) es la principal complicación de la litiasis vesicular. Existe evidencia que respalda el hecho que la proteína C reactiva (PCR) se elevaría en distintos niveles según gravedad de la CA. El objetivo de este estudio fue determinar asociación entre valores de PCR y estadios clínicos de gravedad de CA. Serie de casos consecutivos de adultos con CA diagnosticada por clínica, ultrasonografía y criterios de Tokio; tratados en un centro de salud terciario de La Paz, Bolivia (diciembre 2019 y enero 2020). La variable resultado fue niveles de PCR. Otras de interés fueron variables biodemográficas. Se aplicó estadística descriptiva (cálculo de porcentajes, de medidas de tendencia central y de dispersión); y posteriormente, se aplicaron estadísticas analíticas para estudiar asociación entre variables (test exacto de Fisher para variables categóricas y t de student para variables continuas). Se estudiaron 44 pacientes (33 con CA leve y 10 con CA moderada), con edad promedio de 51,7±15,3 años; 59,1 % de sexo femenino. El peso, estatura e IMC promedio fueron 69,6±10,3 kg; 1,6±0,1 m; y 27,0±3,1 kg/m2 respectivamente. Las cifras promedio de PCR fueron 9,0±11,6 y 29,5±20,2 en los subgrupos CA leve y moderada respectivamente (p=0,001). Los valores de PCR se asociaron a dos estadios de gravedad clínica de CA.

Serum levels of C-reactive protein as a marker of gravity of acute cholecystitis. Prospective series of cases. Acute cholecystitis (AC) is the main complication of cholelithiasis. There is evidence supporting the fact that C-reactive protein (CRP) would rise at different levels depending on severity of AC. The objective of this study was to determine the association between CRP values and clinical stages of CA severity. Series of consecutive cases of adults with AC diagnosed by clinical, ultrasound and Tokyo criteria; treated at a tertiary health center in La Paz, Bolivia between December 2019 and January 2020. The result variable was CRP determination. Others of interest were biodemographic variables. Descriptive statistics (calculation of percentages, measures of central tendency and dispersion) were applied; later, analytical statistics were applied to study the association between variables (Fisher's exact test for categorical variables and Student's t test for continuous variables). Also, 44 patients were treated (33 with mild AC and 10 with moderate AC), with an average age of 51.7±15.3 years; 59.1 % female. Average weight, height and BMI were 69.6±10.3 kg; 1.59±0.1 m; and 27±3.1 kg/m2 respectively. The mean CRP values were 9.0±11.6 and 29.5±20.2 in the mild and moderate AC subgroups respectively (p=0.001). CRP values were associated with two stages of clinical severity of Acute Cholecystitis.

Ascaris lumbricoides, causa de la colecistitis aguda en el servicio de emergencia del Hospital "Alfredo Noboa Montenegro", 2018 / Ascaris lumbricoides, cause of acute cholecystitis in the emergency service of the "Alfredo Noboa Montenegro" Hospital, 2018

Ascaris lumbricoides provoca una de las helmintiasis más frecuentes en los países tropicales, pudiendo producir efectos patológicos en cualquier parte del organismo, siendo los conductos biliales uno de los sitios recurrentes provocando una colecistitis aguda. La CA es una de las principales causas de ingreso al servicio de Emergencia, es una inflamación de la vesícula cuyo diagnóstico oportuno es de vital importancia para la prevención de complicaciones. Por tal razón, determinar la frecuencia de las variables clínicas, de laboratorio y ecográficas, su relación con las comorbilidades asociadas a las características demográficas de los pacientes y el nivel de severidad de la colecistitis aguda causada por la A. lumbricoides de las Guías de Tokio 2018 del Servicio de Emergencia del Hospital Alfredo Noboa Montenegro durante el periodo junio - diciembre 2018, para la elaboración de un esquema diagnóstico. La metodología de investigación fue cuantitativa descriptiva de corte transversal. Dentro de los principales hallazgos, el CA aparece con prevalencia en el género femenino en un 69,41%, promedio de edad de 32 a 45 años, el 10% de 170 pacientes presentaron en su ecografía una forma parasitaria compatible con A. Lumbricoides, los resultados clínicos arrojaron presencia de dolor (67,34%), fiebre (68,65%), náuseas (45,93%); en los laboratorio la Proteína C Reactiva estuvo aumenta en el 94,18% de los casos, en imagenología se refleja presencia de líquido pericolecistico en un 78,82% y un engrosamiento de pared vesicular en un 34,12%. El nivel de severidad registrado según los criterios de las guías de Tokio 2018 fue grado I 35,3%, grado II 47,1% y grado III 17,6%. Se recomienda la estructuración de un esquema diagnóstico oportuno de colecistitis aguda causada por A. Lumbricoides(AU)

Ascaris lumbricoides causes one of the most frequent helminthiases in tropical countries, being able to produce pathological effects in any part of the body, being the bile ducts one of the recurrent sites causing acute cholecystitis. AC is one of the main causes of admission to the Emergency service, it is an inflammation of the gallbladder whose timely diagnosis is of vital importance for the prevention of complications. signs and symptoms, the timely diagnosis is of vital importance for the prevention of complications. For this reason, determine the frequency of clinical, laboratory and ultrasound variables, their relationship with the comorbidities associated with the demographic characteristics of the patients and the level of severity of acute cholecystitis cause of A. lumbricoides of the Tokyo Guidelines 2018 of the Hospital Emergency Service Alfredo Noboa Montenegro during the period June - December 2018, for the elaboration of a diagnostic scheme. The research methodology was quantitative cross-sectional descriptive. Among the main findings that were prevailed in the female gender in 69,41%, average age from 32 to 45 years, 10% of 170 patients presented in their ultrasound a parasitic form compatible with A. lumbricoides, clinical results that prevailed was presence of pain (67.34%), fever (68.65%), nausea (45.93%); in the laboratory findings the C Reactive Protein was increased in 94,18% of cases, in imaging the presence of pericolecist fluid is reflected in 78,82% and a thickening of the vesicular wall in 34,12%. The severity level recorded according to the criteria of the Tokyo 2018 guidelines was grade I 43,53%, grade II 48,24% and grade III 8,24%. The structuring of a timely diagnostic scheme for acute cholecystitis cause of A. lumbricoides is recommended(AU)

Torsión vesicular a propósito de un caso / On a case report of gallbladder torsion

La torsión vesicular es una entidad muy poco frecuente en la que se produce un giro de la vesícula biliar a lo largo de su eje con afectación de la irrigación vascular de forma completa o incompleta. En este artículo presentamos una paciente de 98 años, que fue hospitalizada para tratamiento quirúrgico urgente con diagnóstico de colecistitis aguda; durante el acto quirúrgico se detectó torsión vesicular. Esta enfermedad es frecuente en personas ancianas del sexo femenino. Su diagnóstico preoperatorio es muy difícil y generalmente se realiza en el acto operatorio. El tratamiento es siempre quirúrgico (detorsión de la vesícula y colecistectomía). Por las dificultades diagnósticas que presenta esta enfermedad es importante conocerla para evitar las complicaciones derivadas de una actuación médica tardía(AU)

Gallbladder torsion is an uncommon clinical entity. It is known to occur when of the gallbladder rotation occurs along the axis of the cystic duct and vascular pedicle, with affectation of vascular irrigation in a complete or incomplete form. This article presents a 98-year-old woman, who was hospitalized for emergency surgical treatment with a diagnosis of acute cholecystitis; gallbladder torsion was diagnosed in the operative act. This disease is more frequently found in females and aged patients. The positive preoperative diagnosis of gallbladder torsion is much difficult and is frequently carried out in the operative act. The chosen treatment is to distortion of the gallbladder and cholecystectomy. Knowing gallbladder torsion will permit avoiding the complications derived from an overdue medical intervention(AU)

Acute Cholecystitis in Patients with Scrub Typhus

Acute cholecystitis is a rare complication of scrub typhus. Although a few such cases have been reported in patients with scrub typhus, the clinical course is not well described. Of 12 patients, acute cholecystitis developed in 66.7% (8/12) of patients older than 60 yr. The scrub typhus group with acute cholecystitis had marginal significant longer hospital stay and higher cost than the group without cholecystitis according to propensity score matching. Scrub typhus should be kept in mind as a rare etiology of acute cholecystitis in endemic areas because the typical signs of scrub typhus such as skin rash and eschar can present after the abdominal pain.

Deficiencies of Circulating Mucosal-associated Invariant T Cells and Natural Killer T Cells in Patients with Acute Cholecystitis

Mucosal-associated invariant T (MAIT) cells and natural killer T (NKT) cells are known to play crucial roles in a variety of diseases, including autoimmunity, infectious diseases, and cancers. However, little is known about the roles of these invariant T cells in acute cholecystitis. The purposes of this study were to examine the levels of MAIT cells and NKT cells in patients with acute cholecystitis and to investigate potential relationships between clinical parameters and these cell levels. Thirty patients with pathologically proven acute cholecystitis and 47 age- and sex-matched healthy controls were enrolled. Disease grades were classified according to the revised Tokyo guidelines (TG13) for the severity assessment for acute cholecystitis. Levels of MAIT and NKT cells in peripheral blood were measured by flow cytometry. Circulating MAIT and NKT cell numbers were significantly lower in acute cholecystitis patients than in healthy controls, and these deficiencies in MAIT cells and NKT cell numbers were associated with aging in acute cholecystitis patients. Notably, a reduction in NKT cell numbers was found to be associated with severe TG13 grade, death, and high blood urea nitrogen levels. The study shows numerical deficiencies of circulating MAIT and NKT cells and age-related decline of these invariant T cells. In addition, NKT cell deficiency was associated with acute cholecystitis severity and outcome. These findings provide an information regarding the monitoring of these changes in circulating MAIT and NKT cell numbers during the course of acute cholecystitis and predicting prognosis.

Timing of Cholecystectomy after Percutaneous Cholecystostomy for Acute Cholecystitis / 대한소화기학회지

BACKGROUND/AIMS: Laparoscopic cholecystectomy is the standard treatment for acute cholecystitis. Percutaneous cholecystostomy is an alternative treatment to resolve acute inflammation in patients with severe comorbidities. The purpose of this study is to determine the optimal timing of laparoscopic cholecystectomy after percutaneous cholecystostomy for the patients with acute cholecystitis. METHODS: This retrospective study was conducted in patients who underwent cholecystectomy after percutaneous cholecystostomy from January 2010 through November 2014. Seventy-four patients were included in this study. The patients were divided into two groups by the operation timing. Group I patients underwent cholecystectomy within 10 days after percutaneous cholecystostomy (n=30) and group II patients underwent cholecystectomy at more than 10 days after percutaneous cholecystostomy (n=44). RESULTS: There was no significant difference between groups in conversion rate to open surgery, operation time, perioperative complications rate, and days of hospital stay after operation. However, complications related to cholecystostomy such as catheter dislodgement occurred significantly more often in group II than group I (group I:group II=0%:18.2%; p=0.013). CONCLUSIONS: Timing of laparoscopic cholecystectomy after percutaneous cholecystostomy did not influence postoperative outcomes. However, late surgery caused more complications related to cholecystostomy than early surgery. Therefore, early laparoscopic cholecystectomy should be considered over late surgery after percutaneous cholecystostomy insertion.

El retrato de una lesión de la vía biliar / Portrait of a Bile Duct Injury

El contacto entre la cirugía y la tecnología tuvo su cúspide a finales del siglo XX con el advenimiento de la cirugía laparoscópica. En 1989 Jacques Perissat presentó su técnica de colecistectomía laparoscópica a la Sociedad Americana de Cirujanos Endoscópicos y Gastrointestinales (SAGES), en Louisville Kentucky. Este evento fue el punto de partida que posteriormente siguió el futuro de la cirugía mínimamente invasiva a nivel mundial. El objetivo de éste artículo, es mostrar los distintos escenarios en los que durante una colecistectomía laparoscópica incluso el cirujano más hábil puede verse inmerso: la identificación de una lesión de la vía biliar.

With the advent of laparoscopic surgery toward the end of the 20th Century, the merging of surgery and technology attained new heights. In 1989 JaquesPerissant presented his technique for laparoscopic cholecystectomy at the meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in Louisville , Kentucky. This was the starting point for what was to become in the future the worldwide use of minimally invasive surgery. The aim of this article is to describe those scenarios which, even in the ablest hands, can lead to a bile duct injury during laparoscopic cholecystectomy.

A Case of Gallbladder Tuberculosis Diagnosed by Positive Tuberculosis-Polymerase Chain Reaction / 대한소화기학회지

Gallbladder tuberculosis is an extremely rare disease that is rarely reported in the literature. Arriving at the correct diagnosis of gallbladder tuberculosis is difficult, and it is usually made by histopathologic examination after cholecystectomy. However, due to the low sensitivity of acid-fast stain and culture result, diagnosing gallbladder tuberculosis is still demanding even after tissue acquisition. To overcome this problem, tuberculosis-polymerase chain reaction (TB-PCR) is performed on the resected specimen, which has high sensitivity and specificity. A 70-year-old female who had previously undergone total gastrectomy for advanced gastric cancer was admitted with right upper quadrant pain. Abdominal ultrasonography and computed tomography revealed acute cholecystitis without gallstones or sludge. She underwent cholecystectomy and the histopathologic finding of the specimen showed chronic active cholecystitis without gallstones or sludge. Because she was suspected to have pulmonary tuberculosis, TB-PCR was also performed on the resected gallbladder. TB-PCR showed positive reaction for Mycobacterium tuberculosis and we could diagnose it as gallbladder tuberculosis. Herein, we present a case of gallbladder tuberculosis diagnosed by TB-PCR from resected gallbladder.

A Case of Acute Cholecystitis after Colonoscopy / 대한소화기학회지

A 43-year-old man, who received total gastrectomy five years ago for advanced gastric cancer, underwent a screening colonoscopy and abdominal CT scan. Abdominal CT scan revealed no abnormal findings. Colonoscopy revealed polyps at the rectum, which were removed by polypectomy. The patient did not complain of abdominal pain or discomfort throughout the procedure. But, he developed right upper quadrant abdominal pain on the next day after colonoscopy. Abdominal CT scan revealed the distended gallbladder with mild wall thickening and suspicious sandy stones or sludge in the gallbladder. The patient underwent an open cholecystectomy. Pathology was compatible with acute cholecystitis. We should be aware of and consider cholecystitis in the differential diagnosis for patients with abdominal pain after colonoscopy.

Acute cholecystitis from typhic origin in children

Background: To evaluate the particularities of typhoid cholecystitis in children. Materials and Methods: This was a 5-year prospective study of typhoid cholecystitis in children under 15 years old at Djougou and Sylvanus Olympio teaching hospital. The diagnosis of typhoid cholecystitis was based on clinical and investigation findings; confirmed by operative findings at cholecystectomy. Results: Six children with typhoid acalculous cholecystitis were treated over a five-year period (4 males and 2 females). Their ages ranged from five to 13 years (median 8.8 years). The mean duration of symptoms was six to 21 days. The clinical signs were fever; abdominal pain; which predominated at the right upper abdominal quadrant; and type II Hackett splenomegaly. The diagnosis was confirmed by a positive Widal's test and Salmonella typhi isolation from the culture in all patients; four patients had ultrasound evidence of acalculous cholecystitis. Open cholecystectomy was successful in the six cases. The operative findings were gangrene (3); perforation (2) and empyema (1). All the patients made an uneventful recovery; and have remained symptom free one and three months on follow-up. Conclusion: Typhoid acalculous cholecystitis is a frequent complication in children. Late presentation and diagnosis is associated with complications. Cholecystectomy in association with antibiotic is the treatment of choice

Colecistitis aguda en paciente con situs inversus totalis / Acute cholecystitis in a patient with situs inversus totalis

El objetivo del presente reporte es dar a conocer un caso de situs inversus y colecistitis aguda diagnosticado y tratado en el Hospital Al Wahda Mabar Thamar de Yemen. Paciente de sexo femenino, de 50 años, con dolor en epigastrio después de la ingestión de alimentos grasos. Dos días antes de su ingreso incrementa su intensidad y se mantiene en hipocondrio izquierdo, y además, presenta vómitos. Utilizando antibioticoterapia perioperatoria, se realiza incisión subcostal izquierda, y se encuentra colecistitis aguda con dilatación moderada del colédoco. Se realiza colecistectomía y coledocotomía, con buena evolución posoperatoria(AU)

The objective of present paper is to present a case of situs inversus and cholecystitis diagnosed and treated in the Al Wahda Mabar Thamar Hospital of Yemen. A female patient aged 50 with epigastric pain after ingestion of fatty foods; two days before its admission increase its intensity and remains in left hypochondrium and also vomiting. With the use of perioperative antibiotic-therapy, a left subcostal incision is made detecting an acute cholecystitis with a choledochal slight dilatation. A cholecystectomy and choledochotomy with a good postoperative evolution were performed(AU)

Colecistitis aguda asociada a ascaris lumbricoides / Acute cholecystitis associated with ascaris lumbricoides

Se presenta un caso atendido en el hospital provincial Antonio Luaces de la provincia Ciego de Ávila, Cuba, en el servicio de terapia intermedio, de aparición poco frecuente. Se trata de unpaciente masculino de 44 años de edad que acude a consulta por dolor epigastrio intenso con irradiación a ambos flancos y hacia espalda, de tipo cólico acompañado de fiebre y vómitos. Al examen físico: mucosas ligeramente ictéricas, fiebre (38 graus C), taquicardia (90 latidos por minuto),abdomen ligeramente distendido, ruidos hidroaéreos normales, reacción de defensa a la palpación del hemiabdomen superior donde la percusión es dolorosa. Se realiza ultra-son del abdomen yse arribó al diagnóstico de colecistitis aguda asociado a Ascaris lumbricoides. Se realizó cirugía (colecistectomia), durante la cual se observó la presencia del parasito dentro de la vesícula biliar.

An unusual case attended at Ciego’s provincial Hospital “Antonio Luaces”, Cuba, is described. A male patient, 44 years old, complaining of severe pain of colic type, at epigastrium, with irradiation to both flanks and to the back, accompanied with fever and vomits. On physical examination he presented: slight icteric mucosa, fever (38oC), tachycardia (90 bpm), slightly distended abdomen, normal abdominal sounds, and reaction of defence on the superior abdomen whose percussion was painful. Abdominal ultrasonography showed cholecystitis and an image of Ascaris lumbricoides inside the gallbladder. The patient underwent surgery with cholecystectomy when the presence of the parasite...

Valor predictivo del índice de peritonitis de Mannheim en pacientes con colecistitis aguda / Predictive value of Mannheim's peritonitis rate in patients with acute cholecystitis

OBJETIVO: Determinar el valor predictivo del índice de peritonitis de Mannheim en los pacientes con diagnóstico de colecistitis aguda. MÉTODOS: Se realizó un estudio de corte transversal correlacional en 40 pacientes con el diagnóstico de colecistitis aguda en el Hospital Militar Central Dr. Luis Díaz Soto, entre el 1ro. de julio de 2007 y el 30 de diciembre del 2008. Las variables de estudio fueron: valor de índice de peritonitis de Mannheim, edad, sexo, estado al egreso, factores de riesgo, leucocitosis, proceder quirúrgico y estudio histopatológico. La calidad diagnóstica del índice de peritonitis de Mannheim se midió en términos de sensibilidad y especificidad. El análisis ANOVA y la prueba t se emplearon para determinar la influencia y diferencias significativas entre variables; aquellas que demostraron significación se sometieron a regresión logística con valor p < 0,01 y odds ratio con intervalo de confianza del 95 por ciento, para determinar los factores que de modo independiente influyeron sobre la mortalidad. RESULTADOS: El valor promedio de índice de peritonitis de Mannheim fue de18 (9-31), la mortalidad de la serie de 8 pacientes (20 por ciento). El punto de corte en la curva de operación característica del receptor fue de 23, con un área bajo la curva de ,957. El índice de peritonitis de Mannheim -0,09 [0,014, 0,57] (p= 0,0000) resultó la variable que se correlacionó con la mortalidad. CONCLUSIONES: El índice de peritonitis de Mannheim constituye un sistema de puntuación exacto, oportuno y objetivo para evaluar a pacientes con colecistitis aguda que puede ayudar en la selección de estos para un enfoque terapéutico adecuado

OBJECTIVE: To determine the predictive value of Mannheim's peritonitis rate in patients diagnosed with acute cholecystitis. METHODS: A cross-sectional correlation study was conducted in 40 patients diagnosed with acute cholecystitis seen in Dr. Luis Díaz Soto Central Military Hospital from July 1, 2007 to December 30, 2008. Study variable included: value of Mannheim's peritonitis rate, age, sex, status at discharge, risk factors, leukocytosis, surgical procedure and histopathological study. Diagnostic quality of above mentioned rate was measured in terms of sensitivity and specificity. ANOVA analysis and t test were used to determine the influence and the significant differences among variables; those more significance underwent to a logistic regression analysis with a value of p< 0.01 and odds ratio with a 95 percent CI to determine the factors that in a independent way influenced on mortality. RESULTS: Average value of Mannheim's peritonitis rate was of 18 (9-31), mortality rate in 8 patients (20 percent). Cut-point in operation wave characteristic of recipient was of 23, with an area under the curve of .957. Above mentioned rate -0.09 [0.014, 0.57] (p= 0.0000) was the variable correlated with mortality. CONCLUSIONS: The Mannheim's peritonitis rate is a exact, timely and objective mark helping in the selection of these features to a appropriate therapeutical approach

A Case of Actinomycosis of Gallbladder Presenting as Acute Cholecystitis / 대한소화기학회지

Actinomycosis is a chronic suppurative and granulomatous disease, characterized by the formation of abscess, draining sinuses, abundant granulation, and dense fibrous tissue. Actinomycosis of the gallbladder is extremely rare. We report a case of an 56-years old man who abruptly presented with right upper quadrant abdominal pain. Abdominal CT showed that the gallbladder had 2 cm sized stone and an edematous thick wall. Our preoperative diagnosis was acute calculous cholecystitis. After the management of acute cholecystitis, laparoscopic cholecystectomy was performed but converted to open surgery due to severe adhesion to liver and greater omentum. Partial cholecystectomy was performed. Histologic section of the gallbladder showed sulfur granule with gram-positive branching bacilli compatible with actinomyces. After cholecystectomy, the patient received intravenous penicillin G for 2 weeks, followed by oral penicillin for 3 months.

Vesícula biliar doble: reporte de un caso / Double gallbladder: a case report

Se presenta caso clínico de vesícula biliar doble en paciente femenina de 68 años quien consulta por presentar clínica de colecistitis aguda; el procedimiento quirúrgico se inicia por vía laparoscópica y ante la imposibilidad de identificación de estructuras anatómicas es convertido a cirugía convencional abierta donde se evidencia vesícula biliar doble, cada una de las cuales desembocaba en un conducto cístico separado, ambas con signos de inflamación aguda; una de ellas con múltiples cálculos; la otra, acalculosa, con un pólipo mayor de 1 cm en su interior. El estudio anatomopatológico reportó colecistitis crónica, colecistitis aguda severa y pólipo necrótico, respectivamente. La vesícula biliar doble es una variante anatómica poco frecuente la cual puede ser diagnosticada preoperatoriamente por imaginología y cuyo abordaje laparoscópico resulta exitoso.

We present a case of double gallbladder in a 68 year old female patient with diagnosis of acute cholecystitis. The procedure was converted to conventional open surgery due to difficult identification of biliary tract structures. In the laparotomy we found a double gallbladder with independent cystic duct. In one of gallbladder there was a cholelythiasis and a one centimetre in diameter polyp in the second one. The pathology study concluded acute cholecystitis and necrotic polyp. The double gallbladder is a very unusual anatomic variant. The preoperative diagnosis is based on imagenology and the laparoscopic approach is safe and effective in some cases.

Anestesia conductiva en colecistectomías abiertas: una mejor alternativa en cirugía y relación costo beneficio / Conductive anesthesia in open cholecystectomies: a better alternative in surgery and cost-benefit relationship

Se realizó un estudio retrospectivo de tipo descriptivo, con la revisión de 180 historias médicas de pacientes que ingresaron por el servicio de cirugía, a los cuales se les practicó colecistectomia abierta con anestesia subdural, en el Hospital Fundahosta para el período enero del 2000 hasta enero del 2004, los datos fueron obtenidos de acuerdo a la recolección de 10 parámetros, correspondientes al año de la intervención quirúrgica, edad, sexo, diagnóstico preoperatorio, postoperatorio, modalidad de anestesia, número de aguja subdural, complicaciones, tiempo de estancia, hospitalaria y costo del servicio. Nuestro objetivo es dar a conocer las ventajas que ofrece la anestesia conductiva subdural en relación a la reducción del tiempo operatorio, escasas complicaciones, mejor relación costo beneficio con el que cuenta la institución y garantizar la eficacia de las intervenciones electivas a los pacientes que serán sometidos a este procedimiento.

Colecistitis aguda asociada a sepsis por Staphylococcus aureus en un recién nacido / Acute cholecystitis and Staphylococcus aureus sepsis-related in a newborn

Introducción: La colecistitis aguda es una patología muy infrecuente en el periodo neonatal. Objetivo: Presentar el caso de un recién nacido con una colecistitis aguda asociada a una sepsis por Staphylococcus aureus. Caso clínico: Recién nacido de término, de sexo femenino, de 23 días de vida, que presentó signos clínicos de septicemia, asociado a un abdomen agudo que requirió una laparotomía exploradora encontrándose una vesícula hidrópica e inflamada que requirió de una colecistectomía, la biopsia confirmó una colecistitis aguda. Conclusión: La colecistitis aguda neonatal es una patología muy infrecuente. Clínicamente se presenta como un abdomen agudo o una masa abdominal palpable. El diagnóstico se sospecha con la ecografía y se confirma por laparotomía.

Carcinoma in cholecystectomy specimens of acute cholecystitis

This study was conducted in surgical 'D' ward Khyber Teaching Hospital from July 2003 to June 2005 looking for malignancy in cholecystectomy specimens of acute cholecystitis. A total of 56 patients, 43 females [78%] and 13 male [23.2%] were included in this study. The histopathology reports showed carcinoma in 8 [14.28%] patients. It was observed that number of cases with carcinoma gall bladder with acute cholecystitis was quite high. All cholecystomy specimen should be sent for histopatholgy to detect the clinically non evident malignancy