A case of hemocholecyst associated with hemobilia following radiofrequency ablation therapy for hepatocellular carcinoma / 대한간학회지

Radiofrequency ablation (RFA) is performed as an alternative to surgical resection for primary or secondary liver malignancies. Although RFA can be performed safely in most patients, early and late complications related to mechanical or thermal damage occur in 8-9.5% cases. Hemocholecyst, which refers to hemorrhage of the gallbladder, has been reported with primary gallbladder disease or as a secondary event associated with hemobilia. Hemobilia, defined as hemorrhage in the biliary tract and most commonly associated with accidental or iatrogenic trauma, is a rare complication of RFA. Here we report a case of hemocholecyst associated with hemobilia after RFA for hepatocellular carcinoma that was successfully managed by laparoscopic cholecystectomy.

Management of polypoid lesions of the gall bladder

To analyze the demographic and clinical characteristics of patients diagnosed with polypoidal lesions of gall bladder and to correlate the radiological and histopathological diagnosis. Descriptive study. At Hamdard University Hospital Karachi over a period of 9 years [July 1999- June 2008]. The study included all those patients who were operated for gall bladder polyps. Patients of both sexes above14 years of age diagnosed on the basis of ultrasound and underwent cholecystectomy were included in the study. Twenty eight patients were included in this study with male to female ratio of approximately 1:8. Mean age of patients was 47.5 years. Twenty five patients were having symptomatic gall bladder disease. On the basis of ultrasound 19 patients had solitary polyp while 9 had multiple lesions. All these patients were operated laparoscopically; only one patient had a conversion to open cholecystectomy. Out of total 28 patients 19 were histopathologically proven benign polyps, one patient had severely dysplastic polypoidal lesion while eight patients had chronic cholecystitis with prominent folds with or without gall stones. Of 19 patients with benign disease 15 had cholesterol polyps and remaining 4 had adenomas. Gall bladder polyps are important cause of symptomatic gall bladder disease with peak incidence in 4th to 5th decade. Most of the gall bladder polyps are benign with cholesterol polyps and adenomas being the commonest lesions found on histopathology. Ultrasonography is good diagnostic tool with reasonable accuracy

Cholecysto-hydatid cyst fistula

We present a case of recurrent hydatid cyst liver in a 32-year-old female. Previous surgery was performed 8 years ago elsewhere. Pre-operative assessment at presentation revealed a 110 x 105 mm hydatid cyst in the right lobe of the liver. On exploration, a 5 mm fistulous communication was found between the hydatid cyst and the gallbladder. Patient was subjected to endocystectomy [partial cystectomy], cholecystectomy and closure of the fistula followed by obliteration of the cavity with omentum. Postoperative recovery was uneventful

Gallbladder edema in Dengue hemorrhagic fever and its association with haematocrit levels and type of infections.

AIM: To determine gallbladder edema with type of Dengue infection and hematocrit level. METHODS: A retrospective study was performed on 225 cases of DHF admitted from January to December 1997 to determine the association between the type of Dengue infection, hemoconcentration and the presence or absence of gallbladder edema. Primary or secondary types of Dengue infection consider to determine the severity and degree of plasma leakage in dengue hemorrhagic fever. The Chi square and Spearman 's tests were performed to establish association between variables. RESULTS: out of 225 cases of DHE 129 cases were found with the following dengue serology test results: 92 IgM positive and 37 negative. Abdominal ultrasound was performed in 57 cases, revealing gallbladder edema in 17 cases and none in 40 cases. The 57 cases were classified as primary dengue cases (positive IgMA), secondary dengue(positive IgM and IgG), or seronegative (negative IgM). Primary dengue was found in 5 cases with gallbladder edema and 15 cases without (25%). In the secondary dengue group,10 cases were found with gallbladder edema and 8 cases without (55.5%), while in the non-Dengue group, there were 2 cases with gallbladder edema and 17 cases without (10.5%).There was association between the development of gallbladder edema and the type of dengue infection(p=0.010). Gallbladder edema was more common in secondary Dengue (55%). There was a tendency for gallbladder edema in patients with higher increases in hematocrit. CONCLUSION: It conclude that gallbladder edema is more common in cases of secondary dengue and that there is a tendency for gallbladder edema with higher increase of hematocrit.

Agenesie de la vesicule biliaire: a propos d'une cas.

Agenesis of the gall-bladder is a very rare affection. The pathogeny is correlated with abnormality affecting the embryogenesis of hepatic diverticulum which explain the frequent association with others malformations. The diagnosis is exceptionnaly made preoperatively. Laparotomy confirm the diagnosis and the surgeon must explore the habitual ectopic site by manual explorations, sonography and cholangiography before concluding at the diagnosis of agenesis of gallbladder

A Case of Intraluminal Gallbladder Hematoma after Percutaneous Liver Biopsy / 대한간학회지

Percutaneous liver biopsy is valued in the diagnosis of diffuse or localized liver disease. Serious complications after ultrasonography-guided liver biopsy are rare. We report a case of a 69-year-old man who underwent a percutaneous liver biopsy for the evaluation of his underlying liver disease with subsequent late complication of intraluminal gallbladder hematoma.

Gall bladder perforation and biliary peritonitis in a young pregnant lady.

A rare event of acute free perforation of gall bladder with biliary peritonitis in a case of calculous cholecystitis in a 28 years old pregnant lady occurring in the absence of the usual factors associated with gall stone disease is reported. The clinical features resembled acute appendicitis and a pre-operative diagnosis could not be made. It is suggested that a thorough attempt should be made to exclude conditions mimicking appendicitis, including those of the biliary system, on finding a normal appendix at emergency appendicectomy without hesitating to convert to full laparotomy if required.

Pseudoaneurysm in gall bladder fossa following laparoscopic cholecystectomy.

A 32-year-old lady presented with severe hematemesis and melena after laparoscopic cholecystectomy. Initial ultrasonography and spiral CT suggested a vascular lesion in the gall bladder fossa. Selective hepatic angiography confirmed the presence of a pseudoaneurysm close to the surgical clip and filling through the right hepatic artery. This was treated with coil embolization, resulting in cessation of hematemesis and amelioration of symptoms.

Biliary sludge: a well defined sonographic entity

Objetives: Identify the present of biliary sludge (BS) in our patients, since different authors have concluded that this entity may be an etiologic agent of biliary colic, gallbladder stones and some complications such as acute pancreatitis and acalculous cholecystitis. Methods: We reviewed retrospectively the abdominal sonographic reports of 2802 patients of our gastroenterologic unit, with an average age of 40.5 years. The variables of the protocol were: gallbladder stones, BS and acute and chronic gallbladder inflammation. Results: Considering the mentioned criteria, we entered to the study 2682 patients. 17.8 per cent (n=479) had lithiasis, 13.2 per cent (n=356) had BS, 2 per cent (n=54) had acute gallbladder inflammation and 2.3 per cent (n=64) had chronic gallbladder inflammation. Of the group of patients with BS 42.7 per cent (n=152) were female and 57.3 per cent (n=204) were males. 52 per cent of the patients with BS were between the ages of 26 to 45 years. Conclusions: In our study we found an important prevalence of BS that was over 13 per cent which is higher than the results reported by additional series. Its early sonographic detection, follow-up, removal of precipitating factors and treatment are all adequate measures in order to achieve its elimination.

Pitfalls in the management of Mirizzi's syndrome.

Pressure on the common hepatic duct due to a gallstone impacted in Hartmann's pouch or cystic duct results in jaundice and cholangitis. Repeated episodes of inflammation and pressure necrosis lead to the formation of a cholecysto-choledochal fistula (Mirizzi's syndrome Type I & II). Preoperative diagnosis is difficult and a formal cholecystectomy may lead to bile duct injury. Of the 792 patients operated upon for symptomatic gallstone disease from June 1992 to June 1997 at our centre, 18 patients (2%) had Mirizzi's syndrome. There were 11 females and 5 males, with a mean age of 48 (SD 20; range 20-74) years. Thirteen patients (81%) presented with cholangitis. Ultrasound scan suggested the diagnosis of carcinoma gallbladder in 9 (56%). Endoscopic Retrograde Cholangiopancreatography (ERCP) confirmed the diagnosis in 16. Cholecystectomy was done by the fundus first technique. A complete cholecystectomy was done only if there was no cholecysto-choledochal fistula (n = 5), otherwise a cuff of gallbladder was used to repair the bile duct (n = 10). Hepatico-jejunostomy was done to drain the fistula in one patient. A T-tube drain was placed in the common bile duct (CBD) and a cholangiogram done, before closing the abdomen in all. Histology revealed carcinoma in fundus of gallbladder in one patient (6%). One patient died of haemobilia 3 weeks after operation. Wound infection developed in 5 (30%) patients and 12 (75%) have been followed up for a median period of 28 months. One patient developed a biliary stricture with intrahepatic stones and later underwent a hepatico-jejunostomy. Two have undergone repair of incisional hernia. High index of clinical suspicion, ERCP to clinch the diagnosis, NBD to drain the infected bile, a fundus first partial cholecystectomy and primary repair of CBD, followed by a peroperative T-tube cholangiogram, usually leads to a satisfactory outcome.

Surgical complications of typhoid fever

This is a prospective study, carried out in the Department of Paediatric Surgery. Chandka Medical College Hospital, Larkana from January 1993 to December, 1997. A total of 90 cases of typhoid fever with surgical complications were admitted in the unit. Of 90 patients, 88 had gut and 2 had gall bladder perforations. In majority of patients [61.2%], duration of fever was two or more weeks. Leucopenia was found in 33.3% and pneumoperitoneum in 72.2%; Widal test was positive in 33.3% and blood culture, though done in 40 patients, were positive in all. Laparotomy was done in 89 patients. In 70 patients single and in 17 patients, multiple ileal perforations were present. Surgical procedures performed were: simple double layer closure [80], resection and anastomosis [5], hemicolectomy [2], and cholecystesctomy [2]. Postoperative complications occurred in 36 patients [44.4%]; wound infection being the most common complication [38.2%] in our series. Average hospital stay was 14.2 days. Seven patients [7.7%] died, one preoperatively and six postoperatively

Perforación de vesícula biliar durante el embarazo. Informe de un caso / Bibliary vesicle perforation during pregnancy. One case presentation

Se presenta el caso de una paciente primigesta de 20 años de edad con un embarazo de 38 semanas, que ingresó a la sala de urgencias por un cuadro abdominal agudo por colecistitis, en el momento de la laparotomía se observó la existencia de una perforación en la pared vesicular parcialmente sellada con epiplón y líquido biliar libre en la cavidad peritoneal, practicándosele colecistectomía y operación cesárea 24 horas después. Se analizan las opciones terapéuticas en estas pacientes y los riesgos del tratamiento quirúrgico durante la gestación y fuera de ella

Estudio comparativo macro-microscopico de las lesiones vesiculares en la Plata (Argentina) / Macro-microscopic comparative study of vesicles lesions in La Plata (Argentina)

Hasta hoy, la histogénesis del carcinoma vesicular, sigue siendo controvertida. Algunos autores, insisten en la secuencia pólipocáncer, mientras que otros, vinculan al adenocarcinoma con los cambios metaplásicos y displásicos. Tiene valor el examen macroscópico inmediato de la mucosa, para poder orientar al cirujano en el quirófano. Con el propósito de correlacionar los hallazgos macro-microscópicos de las lesiones vesiculares, se estudiaron 306 piezas de colecistectomías, extendidas y fijadas en formalina. Se consignó: Edad, sexo, litiasis, dimensiones de la pieza y el patrón macroscópico de la superficie mucosa. Se realizaron cortes longitudinales, para su estudio histológico. Doscientos treinta y siete casos correspondieron al sexo femenino (77,4 por ciento) y 69 (22,5 por ciento al masculino, con una edad promedio de 44 años. Entre los hallazgos microscópicos, se destacó. La metaplasia gástrica (43 por ciento), intestinal 10,8 por ciento), displasia de bajo grado (11,8 por ciento) y alto grado (1,6 por ciento) y 2 casos de carcinoma invasor, no sospechados clínicamente (0,6 por ciento). Podría afirmarse la asociación entre colecistitis crónica, litiasis y cambios epiteliales, pero, la relación existente entre cada uno de los patrones macroscópicos propuestos y los hallazgos histológicos, sólo es estadísticamente significativa en aquellos casos de atrofia. Probablemente esto sea debido a la superposición de los hallazgos microscópicos en los diferentes patrones macroscópicos

Vesícula biliar hidrópica na síndrome linfonodomucocutânea (Sindrome de Kawasaki): relato de caso / Hydropic blister gallbladder in mucocutaneous lymph node syndrome (Kawasaki sindrome): a case report

Uma possível manifestaçao da síndrome linfonodomucocutânea (SLMC), ou síndrome de Kawasaki, é a hidropsia da vesícula biliar. Pode apresentar-se com sintomas abdominais previamente ao estabelecimento clínico da síndrome ou aparecer já no curso dela. Existem poucos relatos desta associaçao, com variaçao de incidência estimada entre 3 por cento e 13,7 por cento. Neste relato descrevemos um caso de SLMC numa criança de cinco anos de idade, que na evoluçao apresentou sintomas e sinais de envolvimento abdominal, com ultra-sonografia e tomografia computadorizada de abdome demonstrando a presença de vesícula biliar hidrópica. Tal patologia deve ser lembrada principalmente no diagnóstico diferencial de colangite acalculosa em crianças, devido ao crescente número de casos de SLMC identificados em nosso meio.