Differential diagnosis of gallbladder polypoid lesions by micro-flow imaging / 南方医科大学学报

OBJECTIVE@#To explore the value of micro-flow imaging (MFI) in evaluating blood flow characteristics and differential diagnosis of gallbladder polypoid lesions.@*METHODS@#We retrospectively analyzed the clinical data and ultrasound images of 73 patients with gallbladder polypoid lesions, including 24 patients with pathologically confirmed neoplastic polyps (n=24) and 49 with non-neoplastic polyps (n=49). All the patients underwent conventional ultrasound, MFI and contrast enhanced ultrasound (CEUS) before cholecystectomy. The blood flow characteristics of the lesions in color Doppler flow imaging (CDFI) and MFI were compared, and the consistency of the findings by these two modalities with those of CEUS were evaluated by weighted Kappa consistency test. The diagnostic performance of MFI for gallbladder polypoid lesions was assessed.@*RESULTS@#There were significant differences between MFI and CDFI in the evaluation of blood flow characteristics of gallbladder polypoid lesions (χ2=37.684, P < 0.001). MFI showed better performance than CDFI in displaying the blood flow characteristics of the polyps. The consistency in the findings was 0.118 between CDFI and CEUS and 0.816 between MFI and CEUS. The sensitivity, specificity and accuracy of MFI in distinguishing neoplastic polyps from non-neoplastic polyps were 75.00%, 93.88% and 87.67%, respectively.@*CONCLUSION@#MFI has a good consistency with CEUS in displaying the blood flow characteristics of gallbladder polypoid lesions and can accurately distinguish neoplastic polyps from non-neoplastic polyps, thus providing new ultrasound diagnostic evidence to support clinical decisions on optimal treatments of gallbladder polypoid lesions.

Complete gallbladder duplication: seventh report in world literature

Gallbladder duplication results from a rare abnormality of embriogenesis and is twice as common in women as in men. The signs and symptoms of double gallbladder cholecystitis are the same as those of single gallbladder cholecystitis: strong pain in the epigastric region and right hypochondrium, which may irradiate to the back and be accompanied by nausea and/or vomiting, Murphy positive sign, and pain on palpation of these regions; plastron may also be present. For this reason, many cases are still diagnosed intraoperatively, making surgery difficult and increasing the possibility of biliary tract injury. We report the case of a female patient with epigastric and dorsal pain for 4 days, which worsened with the ingestion of salty and fatty foods and was accompanied by nausea and vomiting. Physical examination showed a positive Murphy sign. A complete abdominal ultrasound examination showed gallbladder duplication, both lithiasic. Magnetic resonance cholangiography confirmed the duplication of the gallbladder and cystic ducts, with a single main biliary tract and acute lithiasic cholecystitis in both gallbladders. A laparoscopic cholecystectomy of both vesicles was performed without complications, and the patient was discharged 3 days after the procedure. (AU)

Gall bladder emptyng in diabetics with gall bladder disease

Gallbladder diseases increase 2-3 folds in diabetics than non diabetics, this explained by impairment of Gallbladder motility, at the same time non surgical approaches needs sufficient gallbladder motility, thence we arranged this study to determine the gallbladder emptying in diabetics [group I IDDM group II NIDDM] with gallbladder disease. 80 patients of both types of diabetes with gallbladder diseases as well as 13 healthy persons as a control subjected for estimatims of fasting and residual gallbladder volume and efection fraction by ultrasaugraphy at the end al this study we found a significant increase in the fasting and residual gallbladder volume as well as significant decrease in gallbladder ejection fraction which means that there is impairment in gallbladder motility which may explain the highe incidence of gallbladder diseases in diabetes and we suggest the addition of caspride for diabetes patients to prevent this impairment in gallbladder motility, to facilitate the choice of non surgical approaches to gallbladder diseases

Review of cholecystectomy for non hemolytic gallstone in single pediatric surgery unit

In the last years following the extensive use of ultrasound scanning an increasing number of children with cholelithiasis has been identified. Prevalence of cholelithiasis has been well reported, and frequency of cholecystectomy had been addressed by some investigators. The aim of our retrospective study was to evaluate the management of children with cholelithiasis observed at the Pediatric and Surgical unit linked to the Maternity and Child Teaching Hospital. The records of all patients below age of 14 years, undergoing cholecystectomy for cholelithiasis, at Maternity and Child Teaching Hospital in Al- Qadisiya governorate in Iraq, from January 2005 to December 2008 were reviewed. A total of 13 pediatric patients were included in this study. Participants had a mean age of 5.6 years [SD, 2.9 years; range, 2.5-13]. There were 9 female and 4 male patients. Diagnosis of cholelithiasis was performed in all patients by ultrasound exam. All patients underwent cholecystectomy and extensive evaluations for their abdominal pain. The cause for gallbladder disease was identified as personal and familial anamnesis in 4 patients [30.7%]. Intra- and post-surgery course was adequate in all patients, but 2 who had transient complications. In our experience, approach to patients with gallbladder stones was heterogeneous suggesting the need for a common protocol. However, our data show that etiology, sex incidence, diagnosis's modality and management of pediatric patients with gallbladder stones is comparable to previous reported casistics. Pediatricians and pediatric surgeons have to consider that cholelithiasis can occur in children. Common diagnostic, therapeutic and follow-up protocols are needed to improve our knowledge on this pediatric disease

Complications of laparoscopic cholecystectomy in acute cholecystitis

To assess the clinical outcome of laparoscopic cholecystectomy in the management of acute cholecystitis. Descriptive study. Surgical Units II and III of Chandka Medical College Hospital Larkana, from 01.10.2003 up to 31.12.07. In this study 100 consecutive cases of clinically and sonologically confirmed acute cholecystitis who underwent early laparoscopic cholecystectomy [within 07 days of attack] were included. Patients with symptoms of more than one week duration or those with associated diseases were excluded. There was female preponderance with male to female ratio 1:4.5. Mean age was 45.75 years [SD +/- 11.99 years]. Most of the patients were received within 24 hours after the onset of symptoms. Ultrasound revealed edematous gall bladder [GB] in 24 cases, contracted GB in ten, empyema in eight, perforated GB in four. Fifty four patients had acute cholecystitis with cholelithiasis. Peroperative complications were minor bleeding in 6 patients, minor injury to liver bed in 3, major bleeding occurred in two cases that required conversion to open surgery .Other findings which delayed the procedure or required conversion were adhesions with omentum, stomach, colon, CBD, and distorted anatomy of Calot's triangle and CBD injury. The conversion rate was 6% among them two were due to bleeding, two with friable adhesions, one with obscure anatomy. Stone in CBD could not be detected on ultrasound in one case and CBD injury occurred in one. The minimum time taken for the procedure was 50 minutes. No mortality occurred in this series. Emergency / early cholecystectomy is reliable, safe and cost effective modality, in the management of acute cholecystitis. It results in accelerated recovery, negligible wound infection or related complications, and less postoperative pain. Certain factors are responsible for conversions which are obscure anatomy, bleeding, adhesions, and CBD, injury

Ultrasound findings in acute viral hepatitis.

AIM: Serological markers for the virus remain mainstay of diagnosis of acute viral hepatitis. However, it is not available in all part of our country. The aim of this study is to find out the sonological findings of the hepatobiliary system that may aid to clinch the diagnosis of acute viral hepatitis. MATERIALS AND METHODS: One hundred seventy seven consecutive patients with clinical diagnosis of acute viral hepatitis from June 2004 to June 2006 attending liver clinic were enrolled in this study. After exclusion of 32 patients 145 patients with definitive diagnosis by serological confirmation were studied. RESULT: Hepatitis E (85%) was most common followed by B (10%) and A (5%). Gall bladder finding was more common than hepato-splenomegaly. Collapsed gall bladder with increased wall thickness and pericholecystic oedema was present in more than 50% of the patient. In HAV hepatitis it was present in all patients while in HEV hepatitis it was present in 84% patients. CONCLUSIONS: Gall bladder findings in ultrasound are present in over 80% of enterically transmitted hepatitis virus. Thus, it can be used to diagnose acute hepatitis when serological tests are not available.

Role of ultrasonography in patients with normal oral cholecystogram.

The role of real-time ultrasonography was evaluated in 50 randomly selected cases with a strong clinical suspicion of gallbladder diseases and normal oral cholecystogram. Of these, 13(26%) cases showed abnormalities on ultrasonography.

Giant gall bladder diverticulum.

Diverticula of the gall bladder are very rare. We present here a patient with a giant diverticulum of the gall bladder with features of cholecystitis and cholelithiasis.