Cholecystectomy for Biliary Hyperkinesia.

Patients with classic biliary colic symptoms and documented gallbladder ejection fractions on the higher end of the spectrum on hepatobiliary iminoacetic acid scans with cholecystokinin stimulation are presently understudied and the benefits of cholecystectomy are unclear. To determine whether patients with biliary-type pain and biliary hyperkinesia (defined as a gallbladder ejection fractions of 80% or greater) benefit from laparoscopic cholecystectomy, a retrospective chart review encompassing five community hospitals was performed. Patients 16 years and older with diagnosed biliary hyperkinesia who underwent laparoscopic cholecystectomy between January 1, 2010 and May 31, 2015 were included. Pathology reports were reviewed for histologic changes indicating cholecystitis. Resolution of biliary colic symptoms was reviewed one to three weeks after surgery in their postoperative follow-up documentation. Within our study cohort, we found 97 patients who underwent laparoscopic cholecystectomy for biliary hyperkinesia. Within this population, 84.5 per cent of patients undergoing laparoscopic cholecystectomy for biliary hyperkinesia had positive findings for gallbladder disease on final pathology. Of the 77 patients with data available from their first postoperative visit, 70 (90.9%) reported improvement or resolution of symptoms. Our findings suggest that symptomatic biliary hyperkinesia may be treated successfully with surgery.

Delayed intracranial hemorrhage in the patient with blunt trauma on anticoagulant or antiplatelet agents: routine repeat head computed tomography is unnecessary.

OBJECTIVE: We postulate that in patients with blunt trauma on anticoagulant or antiplatelet agents, incidence and complication rate of delayed intracranial hemorrhage (DICH) after an initially negative head CT is low and routine repeat head CT is not warranted. DESIGN: A retrospective, observational study performed from 2008 to 2012. PATIENTS: A total of 338 patients with blunt trauma with pre-admission history of any anticoagulant use, who had an initially negative head CT, followed by a repeat CT within 48 hours. INTERVENTIONS: There were no interventions, this was an observational study only. MEASUREMENTS AND MAIN RESULTS: The sample had mean ISS of 8.6 and an average GCS of 15. 55% had obvious head trauma, 27.2% reported LOC. Incidence of DICH was 2.4% (8/338). All patients with DICH were taking aspirin (ASA) either alone or in combination with another anticoagulant. Of the eight patients with DICH, none required medical or surgical intervention and there were no mortalities. We identified no significant predictors of delayed ICH. CONCLUSIONS: Routine repeat head CT in patients with blunt trauma taking anticoagulant or antiplatelet agents is unnecessary. Incidence of DICH is low and, when found, DICH was clinically insignificant. We recommend close supervision in this population, especially those taking ASA alone or in combination with another anticoagulant.