scholarly journals Signal Intensity of Superb Microvascular Imaging Correlates with the Severity of Acute Cholecystitis

2016 ◽  
Vol 10 (2) ◽  
pp. 452-458 ◽  
Author(s):  
Minoru Tomizawa ◽  
Fuminobu Shinozaki ◽  
Yasufumi Motoyoshi ◽  
Takao Sugiyama ◽  
Shigenori Yamamoto ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Signal Intensity ◽  
Gallbladder Wall ◽  
Abdominal Ultrasonography ◽  
Small Vessels ◽  
Protein Levels ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Superb Microvascular Imaging ◽  
Upper Abdominal ◽  
Microvascular Imaging

Evaluation of the severity of acute cholecystitis is critical for the management of this condition. Superb microvascular imaging (SMI) enables the assessment of slow blood flow of small vessels without any contrast medium. An 84-year-old man visited our hospital with right upper abdominal pain. Computed tomography and abdominal ultrasonography showed a slight thickening of the gallbladder. White blood cell count and C-reactive protein levels were elevated. He was diagnosed with acute cholecystitis and treated conservatively with antibiotics. Two days later, his condition worsened and percutaneous transhepatic gallbladder drainage (PTGBD) was performed. The patient recovered and was discharged, and his drainage was withdrawn 7 days later. On admission, color-coded SMI (cSMI) showed pulsatory signals on the slightly thickened gallbladder wall. On the day of PTGBD, the intensity of the signal on cSMI had increased. Once the patient was cured, no further signal was observed on the gallbladder wall with either cSMI or mSMI. In conclusion, the strong pulsatory signal correlated with the severity of acute cholecystitis observed with cSMI and mSMI. Illustrating the signal intensity is useful for the evaluation of the severity of acute cholecystitis.

scholarly journals Heterotopic Pancreas in the Gallbladder: Case Report and Literature Review

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Emad Aborajooh ◽  
Ibrahim Khalil Khairi Ghayada ◽  
Yasser Mustafa Issa Lafi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Literature Review ◽  
Acute Cholecystitis ◽  
Gallbladder Wall ◽  
Pancreatic Tissue ◽  
Heterotopic Pancreas ◽  
Abdominal Ultrasonography ◽  
Pancreatic Acini ◽  
Case Presentation ◽  
Upper Abdominal

Introduction. Heterotopic pancreas (HP) is the congenital presence of pancreatic tissue outside its normal location in the absence of vascular and anatomical connection with the main pancreas. HP can affect any part of the gastrointestinal tract, and it is mostly encountered in the stomach. The gallbladder is a rare site of HP, and our literature review revealed that only 38 cases were reported. We present a case of HP in the gallbladder that was presented with a picture of acute cholecystitis. After the case presentation, we will discuss HP in the gallbladder by reviewing the literature. Case Presentation. A 49-year-old male presented to the emergency department complaining of progressively worsening right upper abdominal pain for the last 24 hours. After thorough history and physical examination, a provisional diagnosis of acute cholecystitis was made. Abdominal ultrasonography revealed a rim of edema surrounding the gallbladder wall with two stones impacted at the gallbladder neck. Laparoscopic cholecystectomy was performed with an uneventful postoperative course, and the patient was discharged the next day. Microscopic examination of the gallbladder showed that a heterotopic pancreatic tissue, composed of a large number of pancreatic acini and few ducts with the absence of islets of Langerhans, was found around the cystic duct. The patient was asymptomatic at the regular follow-up six months postoperatively. Conclusion. HP in the gallbladder is an extremely rare finding. Its clinical presentation is not different from other cholecystopathic diseases. Most cases were accompanied by cholelithiasis. Preoperative laboratory and imaging modalities are usually not helpful in the diagnosis of HP in the gallbladder. The definitive diagnosis is made by histological examination of the gallbladder specimen. Laparoscopic cholecystectomy is sufficing treatment.

scholarly journals Preoperative Magnetic Resonance Cholangiopancreatography for Detecting Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 383
Author(s):  
Kojiro Omiya ◽  
Kazuhiro Hiramatsu ◽  
Yoshihisa Shibata ◽  
Masahide Fukaya ◽  
Masahiro Fujii ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Magnetic Resonance ◽  
Acute Cholecystitis ◽  
Signal Intensity ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Gallbladder Wall ◽  
High Signal ◽  
Mri Findings ◽  
Open Conversion ◽  
Preoperative Magnetic Resonance

Previous studies have shown that signal intensity variations in the gallbladder wall on magnetic resonance imaging (MRI) are associated with necrosis and fibrosis in the gallbladder of acute cholecystitis (AC). However, the association between MRI findings and operative outcomes remains unclear. We retrospectively identified 321 patients who underwent preoperative magnetic resonance cholangiopancreatography (MRCP) and early laparoscopic cholecystectomy (LC) for AC. Based on the gallbladder wall signal intensity on MRI, these patients were divided into high signal intensity (HSI), intermediate signal intensity (ISI), and low signal intensity (LSI) groups. Comparisons of bailout procedure rates (open conversion and laparoscopic subtotal cholecystectomy) and operating times were performed. The recorded bailout procedure rates were 6.8% (7/103 cases), 26.7% (31/116 cases), and 40.2% (41/102 cases), and the median operating times were 95, 110, and 138 minutes in the HSI, ISI, and LSI groups, respectively (both p < 0.001). During the multivariate analysis, the LSI of the gallbladder wall was an independent predictor of both the bailout procedure (odds ratio [OR] 5.30; 95% CI 2.11–13.30; p < 0.001) and prolonged surgery (≥144 min) (OR 6.10, 95% CI 2.74–13.60, p < 0.001). Preoperative MRCP/MRI assessment could be a novel method for predicting surgical difficulty during LC for AC.

Biliary pain in the structure of episodes of right upper abdominal pain

2020 ◽  
Vol 18 (6) ◽  
pp. 42-52
Author(s):  
Yu.O. Shulpekova ◽  
◽  
V.M. Nechaev ◽  
V.T. Ivashkin ◽  
◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Cholecystitis ◽  
Heart Diseases ◽  
Biliary Colic ◽  
Recurrent Pain ◽  
Biliary Pain ◽  
Abdominal Ultrasonography ◽  
Locomotor System ◽  
Upper Abdominal ◽  
The Right

Acute or recurrent pain in the right upper part of the abdomen is a common cause for visits to physicians. Not less than two thirds of episodes of pain in this area are conditioned by biliary colic and acute cholecystitis. Other most common causes include diseases of the liver, pancreas, prepyloric and pyloric parts of the stomach and the beginning portion of the small intestine, the right kidney, and also subhepatic appendicitis. Some cases of developing pain are associated with the right lung affection and involvement of the diaphragmatic pleura, with heart diseases, involvement of the locomotor system and nerves. Taking into account a high prevalence of cholelithiasis in Russia – around 10–12% – we can conclude that episodes of biliary colic develop every year in 1 of 500–1000 individuals. In Russia, approximately half a million cholecystectomies are performed annually. The prevalence of gall stones among the paediatric population amounts to 2%. As distinct from adults, who in 80% of cases have an asymptomatic course of disease, pain episodes in children manifest themselves in 60–67% of cases. The diiagnosis of acute cholecystitis might meet with considerable difficulties; a scale for assessment of the likelihood of acute cholecystitis has been developed. Unlike in adults, in children a significantly large proportion of cases occur due to acalculous cholecystitis. Differentiating the causes of pain might be difficult, therefore, its character and concomitant symptoms should be thoroughly analysed, and the findings of additional examinations should also be taken into consideration (at the first step – assessment of haematological and biochemical parameters, urinalysis, electrocardiogram and abdominal ultrasonography). Key words: right upper abdominal pain, biliary colic, biliary dyskinesia, cholelithiasis

scholarly journals Acute acalculous cholecystitis on a COVID-19 patient: a case report

2020 ◽  
Author(s):  
Edoardo Mattone ◽  
Maria Sofia ◽  
Elena Schembari ◽  
Valentina Palumbo ◽  
Rosario Bonaccorso ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Gastrointestinal Symptoms ◽  
Acalculous Cholecystitis ◽  
Gallbladder Wall ◽  
Acute Acalculous Cholecystitis ◽  
Surgical Risk ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Vascular Insufficiency ◽  
High Surgical Risk

Abstract Background coronavirus disease-19 (COVID-19) has spread to several countries around the world and has become an unprecedented pandemic. We report an extremely rare case of acute acalculous cholecystitis on a COVID-19 patient. In our knowledge, this is the first report of laparoscopic cholecystectomy performed on a COVID-19 patient. Case presentation: a COVID-19 patient was diagnosed with acute acalculous cholecystitis and a multidisciplinary team decided to perform a percutaneous transhepatic biliary drainage (PTBD) as the first treatment. SARS-CoV-2 RNA was not found in the bile fluid. Because of deterioration of the patient’s clinical conditions, laparoscopic cholecystectomy had to be performed and since the gallbladder was gangrenous, the severe inflammation made surgery difficult to perform. Conclusions acalculous cholecystitis was related with mechanical ventilation and prolonged total parenteral nutrition, in this case the gangrenous histopathology pattern and the gallbladder wall ischemia was probably caused by vascular insufficiency secondary to severe acute respiratory distress syndrome of COVID-19 pneumonia. The percutaneous transhepatic gallbladder drainage (PTBD) was performed according to Tokyo Guidelines because of high surgical risk. Laparoscopic cholecystectomy was next performed due to no clinical improvement. The absence of viral RNA in the bile highlights that SARS-CoV-2 is not eliminated with the bile while it probably infects small intestinal enterocytes which is responsible of gastrointestinal symptoms such as anorexia, nausea, vomiting, and diarrhea. Although the lack of evidence and guidelines about the management of patient with acute cholecystitis during COVID-19 pandemic, laparoscopic cholecystectomy, at most preceded by PTGBD on high surgical risk patients, remains the gold standard for the treatment of acute cholecystitis on COVID-19 patients.

scholarly journals Superb Microvascular Imaging: Added Value and Novel Applications

2017 ◽  
Vol 7 ◽  
pp. 45 ◽  
Author(s):  
Suheil Artul ◽  
William Nseir ◽  
Zaher Armaly ◽  
Michalle Soudack
Keyword(s):  
Power Doppler ◽  
Added Value ◽  
Medical Systems ◽  
Low Velocity ◽  
Sonographic Examination ◽  
Small Vessels ◽  
Vascular Flow ◽  
Superb Microvascular Imaging ◽  
Microvascular Imaging ◽  
Color And Power Doppler

Determining the presence and characteristics of vascular flow is an essential part of sonography interrogation. However, small vessels and low velocities are not always possible to depict with conventional color and power Doppler ultrasound. This can be frustrating, especially when the diagnosis depends mainly on the existence of vascular flow, the sonographic examination will be inconclusive, further imaging examinations will be required and diagnosis delayed. Superb microvascular imaging (SMI) is a novel vascular imaging mode, which provides visualization of low velocity and microvascular flow. SMI uses a clutter suppression algorithm to extract flow signals and depicts this information as a color overlay image or as a monochrome or color map of flow. By using SMI, high frame rates and high-resolution images remain maintained. With SMI, it is possible to visualize small vessels including their branches that, until now, it is possible to demonstrate only using contrast-enhanced ultrasound. Availability of this additional technology on all ultrasound machines may make some of the computed tomography scans unnecessary. In our paper, we describe six patients, aged 16–73 years, in which final diagnosis was achieved only with SMI and where conventional color and power Doppler failed. All these examinations were performed using Aplio 500 Platinum ultrasound unit (Toshiba Medical Systems, Tokyo, Japan).

Efficacy of Superb Microvascular Imaging for Diagnosing Acute Cholecystitis: Comparison with Conventional Ultrasonography

2018 ◽  
Vol 44 (9) ◽  
pp. 1968-1977 ◽  
Author(s):  
Joon Chul Ra ◽  
Eun Sun Lee ◽  
Hyun Jeong Park ◽  
Hee Sung Kim ◽  
Jong Beum Lee ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Superb Microvascular Imaging ◽  
Microvascular Imaging

Evaluation of Preoperative Risk Factors for Converting Laparoscopic to Open Cholecystectomy

2012 ◽  
Vol 78 (8) ◽  
pp. 831-833 ◽  
Author(s):  
Nathan W. Lee ◽  
J. Collins ◽  
R. Britt ◽  
L.D. Britt
Keyword(s):  
Risk Factors ◽  
Abdominal Surgery ◽  
Acute Cholecystitis ◽  
Preoperative Diagnosis ◽  
Open Cholecystectomy ◽  
Gallbladder Wall ◽  
Preoperative Risk ◽  
Preoperative Risk Factors ◽  
Upper Abdominal Surgery ◽  
Upper Abdominal

Performing laparoscopic cholecystectomy (LC) always carries the risk of having to convert from laparoscopic to open cholecystectomy (LOC). Being able to identify these patients preoperatively may allow better preoperative planning and lowering operative cost. All LC and LOC were performed by the Eastern Virginia Medical School Department of Surgery retrospectively identified between January 2008 and December 2009. Preoperative risk factors identified in both groups included: age, gender, body mass index greater than 30 kg/m2, diabetes mellitus, previous upper abdominal surgery, previous abdominal surgery, presence of pericholecystic fluid, gallbladder wall thickness greater than 3 mm, preoperative diagnosis of acute cholecystitis, and pancreatitis. Reasons for conversion in the LOC group were identified from the operative note. A total of 346 LC and LOC were identified. The LOC group had 41 identified with a conversion rate of 11.9 per cent. The LOC group was compared with 100 randomly chosen LC. Risk factors that reached statistical significance for conversion included advanced age, male gender, previous upper abdominal surgery, preoperative diagnosis of acute cholecystitis, and gallbladder wall thickness greater than 3 mm ( P = 0.0009). Average operative time was higher in LOC compared with open cholecystectomy (123 minutes average vs 109 minutes average). Of the reasons for conversion, the degree of inflammation was the most common (51.2%). Preoperative risk factors that were associated with need for conversion were advanced age, male gender, previous upper abdominal surgery, preoperative diagnosis of acute cholecystitis, and pericholecystitic fluid. In patients who have all of these risk factors, we recommend starting with an open cholecystectomy. This will save operative time and overall cost.

The role of upper abdominal ultrasonography in suspected acute cholecystitis

1980 ◽  
Vol 31 (2) ◽  
pp. 175-179 ◽  
Author(s):  
E. Dillon ◽  
G.J.S. Parkin
Keyword(s):  
Acute Cholecystitis ◽  
Abdominal Ultrasonography ◽  
Upper Abdominal

Features superb microvascular imaging (SMI) technique in the differential diagnosis of focal liver formations

2016 ◽  
Vol 37 (S 01) ◽  
Author(s):  
K Korneev ◽  
V Dvornichenko ◽  
A Shelekhov ◽  
Y Senkin ◽  
A Zhdanov ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Superb Microvascular Imaging ◽  
Microvascular Imaging
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