Vólvulo de vesícula: a propósito de un caso / Gallbladder volvulus: about case

El vólvulo de vesícula es una enfermedad poco frecuente en la población, se presenta en personas adultas, de predominio en mujeres. Se describen tres anormalidades, la primera de tipo congénito que ocurre durante el desarrollo embriológico, con ausencia de mesenterio vesicular formando una vesícula libre y flotante. La segunda ocurre por visceroptosis generalizada, en la que el mesenterio de la vesícula y el conducto cístico se relaja y se elonga y la tercera menos frecuente que se caracteriza por una vesícula con su fosa normal en la que el órgano y el lóbulo hepático carecen de ligamento coronario y triangular. El diagnóstico preoperatorio de esta entidad ha sido facilitado con el uso de la ecografía y la TC, los signos imagenológicos son la presencia de la vesícula fuera de su fosa anatómica e inferior del hígado, imagen cónica del cuello, aumento de tamaño y engrosamiento de su pared, puede existir o no litiasis. Los signos de inflamación, isquemia y gangrena de la vesícula son otros hallazgos. La TC y la ecografía son bastante útiles para demostrar complicaciones, como colecciones perivesiculares, trombosis portal y ruptura.

Gallbladder volvulus is a rare disease in the population, occurs in adults, predominantly women. Three abnormalities, congenital first type that occurs during embryonic development, absence of vesicular mesentery forming a free-floating bladder are described. The second general visceroptosis occurs, in which the mesentery of the gallbladder and the cystic duct and relaxing elongates and less frequent third characterized by a vesicle with its normal pit in which the body and lack lobe coronary and triangular ligament. Preoperative diagnosis of this entity has been facilitated with the use of ultrasound and CT, the imaging signs are the presence of the bladder out of your liver and lower anatomical pit picture taper neck, enlargement and thickening of the wall, there may be stones or not. Signs of inflammation, ischemia and gangrene of the gallbladder are other findings. CT and ultrasound are quite useful to show complications such as perivesicular collections, portal vein thrombosis and rupture.

Cholecysto cholangiography versus cystic duct cholangiography in laparoscopic cholecystectomy: a prospective controlled randomized trial

This study evaluated the safety and effectiveness of cholecysto-cholangiography [CCC], an extremely rapid and easy way of imaging the biliary tree during laparoscopic cholecystectomy and a viable alternative to cystic duct cholangiography in the era of minimal invasive surgery. Sixty patients with symptomatic gallbladder stones were studied in this series, 30 were evaluated for cholecysto-cholangiography and other 30 for transcystic-cholangiography. The success rate in cholecysto-cholangiography approached 80% with excellent quality films obtained. Delineation of anatomy approached 85%; 75% for cholecysto-cholangiography and transcystic cholangiography respectively. Exposure time to radiation compares favourably with cystic duct cannulation with a mean time 2.4 min. Cholecysto-cholangiography added less than 11 mins to the procedure; mean 10.4 mins, while transcystic cholangiography added an extra 30 mins; mean 31 mins. There were no cholangiogram related complications or false positive findings with a smooth for two months follow up