scholarly journals Atypical presentation of cholecystitis with torsion of the gallbladder diagnosed preoperatively in an unusual location

2021 ◽  
Author(s):  
Sowmiya Kalyanasundaram ◽  
Suresh Fernando
Keyword(s):  
Gall Bladder ◽  
Ct Scan ◽  
Acute Cholecystitis ◽  
Imaging Modality ◽  
Cross Sectional Study ◽  
Imaging Modalities ◽  
Anatomical Location ◽  
Sectional Study ◽  
Cross Sectional ◽  
Upper Abdomen

Objective: An 87-year-old attended the emergency department with sharp upper abdominal pain, radiating to back with a pain score of 10/10. On examination, severe epigastric tenderness was noted. Past surgical history: bilateral salphingo-oopherectomy. Repair for paraumblical hernia and right total hip replacement. No history of cholecystectomy. Inflammatory markers were raised. Cholecystitis/gall bladder perforation was suspected and contrast CT was performed. Methods: CT abdomen and pelvis – in comparison to the previous CT scan which was done in 2018, where gall bladder was in the correct anatomical location, the gall bladder was not seen in the gall bladder fossa in the current study. However, a gall bladder like suspicious structure was noticed within the upper abdomen to the left of midline anterior to the gastric pylorus with significant inflammatory changes. Therefore, considering the clinical picture and CT findings, it was suggestive of acute cholecystitis with torsion of gall bladder. Results: Patient was started on i.v. antibiotics and laparoscopic assessment was carried out on the following day. Intraoperatively, the surgeons were unable to locate the gall bladder in its normal anatomical position, but incidentally found a mass in the left upper abdomen which appeared gangrenous. This was removed and sent for histopathology. Histology report confirmed that the specimen was gall bladder with features suggestive of pre-existing chronic cholecystitis, with recent venous infarction. Conclusion: Torsion of gall bladder is a very rare entity and if left untreated could lead to fatal sequelae of gangrene and perforation resulting in biliary peritonitis. There is evidence which suggest that torsion of gall bladder is more common in elderly females due to loss of visceral fat but the pre-operative diagnosis using imaging modalities has always been challenging. But in this particular case, the radiologist was able to make the precise diagnosis pre-operatively using the cross-sectional study of an advanced imaging modality like the CT scan with contrast which also helped the surgeons in making the decision for immediate surgery rather than planning for routine conservative management for acute cholecystitis. The importance of cross-sectional study with intravenous contrast in diagnosing unusual presentation of gall bladder related and potentially life-threatening abdominal pathology has been highlighted in this case study. It is also evident that how imaging modalities play a significant role in altering acute management plan.

scholarly journals Isolated Gall Bladder Perforation in A Tertiary Care Hospital in Eastern Nepal: A Descriptive Cross-sectional Study

2020 ◽  
Vol 58 (232) ◽  
Author(s):  
Brikh Raj Joshi ◽  
Swotantra Gautam ◽  
Saroj Adhikari Yadav ◽  
Sushil Dhakal ◽  
Rasmita Thapaliya ◽  
...  
Keyword(s):  
Gall Bladder ◽  
Acute Cholecystitis ◽  
Cross Sectional Study ◽  
Bladder Perforation ◽  
Histopathological Diagnosis ◽  
Type I ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Co Morbidity

Introduction: Cholelithiasisis is a common surgical problem worldwide. Gall bladder perforation is a rare life-threatening complication with considerable mortality. This study aims to find the etiology, demography, type of perforation, and outcome of gall bladder perforation. Methods: This descriptive cross-sectional study was done on patients above 18 years of age visiting the department of surgery of B. P. Koirala Institute of Health Sciences (BPKIHS) who were diagnosed with isolated gall bladder perforation. The study was done from 1st January 2006 till 30 December 2016. Ethical approval was obtained from the Institutional Research Committee (reference number. 34/074/075). The convenient sampling method was used. Data were entered in excel sheets and analyzed. Results: Out of 49 patients included in the study, 28 (57.14%) were females and the commonest age group was 36 to 50 years 22 (44.9%) followed by 51 to 65 years 16 (32.6%). Most of the patients presented in emergency with pain in their abdomen. Diabetes mellitus was the commonest co-morbidity present in 10 (20.41%) patients. Operative management was done in 45 (91.84%) of the patient and conservative management in 4 (8.16%). After surgery of 45 patients, 43 (95.56%) improved and 2 (4.44%) expired. The most common type of perforation was Niemeier Type I in 21 (46.67%) followed by Type III 14 (31.11%). The most common histopathological diagnosis was acute cholecystitis 20 (44.44%). Conclusions: Isolated gall bladder perforation is not an uncommon complication. The most common etiological factor was acute cholecystitis with a slight female predominance. Most of the patients needed surgical intervention and they had good outcomes when diagnosed and managed on time.

INCIDENTAL GALL BLADDER CARCINOMA (IGBC) IN CHOLECYSTECTOMY SPECIMENS REMOVED FOR CHOLELITHIASIS

2021 ◽  
Vol 5 (10) ◽  
Author(s):  
Dharmpal Godara ◽  
Vijay Pal Singh Dhayal
Keyword(s):  
Gall Bladder ◽  
Bladder Carcinoma ◽  
Histopathological Examination ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Survival Outcome ◽  
Sectional Study ◽  
Gall Bladder Carcinoma ◽  
Cross Sectional ◽  
Hospital Records

Background: The present study highlights the occurrence of Incidental gallbladder carcinoma (IGBC) detected during histopathological examination in cholecystectomy specimens removed for cholelithiasis. Methods- This is a tertiary hospital based cross-sectional study of 500 cholecystectomy specimens removed during cholelithiasis. Relevant hospital records, histopathology slides and reports were reviewed, re-evaluated and studied. Results: 4(0.80%) cases of incidental gall bladder carcinoma (IGBC) were diagnosed from the histopathological evaluation (HPE) of 500 cholecystectomy specimens, constituting 0.80% of gall bladder specimens received during the study period. The age of the patients with IGBC ranged from 51-80 years. More females were affected than males with a M:F ratio of 1:3. Conclusion: Early detection of IGBC by histopathological examination would have a favourable impact on prognosis and management thereby increasing the survival outcome. Keywords: Cholelithiasis, Incidental Gall Bladder Carcinoma

Midline anomalies and organic psychosis: congenital or degenerative? A cross-sectional study of 62 patients with Andermann syndrome

1992 ◽  
Vol 7 (3) ◽  
pp. 109-113 ◽  
Author(s):  
MJ Filteau ◽  
E Pourcher ◽  
RH Bouchard ◽  
P Baruch ◽  
J Mathieu ◽  
...  
Keyword(s):  
Early Childhood ◽  
Ct Scan ◽  
Cross Sectional Study ◽  
Dementia Praecox ◽  
Ventricular Size ◽  
Sectional Study ◽  
Organic Psychosis ◽  
Cross Sectional ◽  
Schizophrenic Patients ◽  
Degenerative Processes

Brain alterations have been sought since the beginning of the century to explain the ‘dementia’ of dementia præcox. Kraepelin suggested in 1913 that it might have its internal origins in early childhood, while Southard (1915) considered likely a congenital or early acquired basis for the development of the disease. Afterwards, degenerative processes were described for decades until neurodevelopmental theories emerged recently (Lewis, 1988).Using pneumoencephalography, Jacobi and Winkler (1927) first reported that some patients with schizophrenia presented enlarged ventricles. Johnstone et al (1976, 1978), in CT-scan studies, observed an increase in mean lateral ventricular size in a group of institutionalized schizophrenic patients. This finding has been replicated by other studies (Weinberger et al, 1983) but challenged by others (Gluck et al, 1980; Jernigan et al, 1982).

EFFECTIVE DOSE FOR RADIOLOGICAL PROCEDURES IN AN EMERGENCY DEPARTMENT: A CROSS-SECTIONAL STUDY

2020 ◽  
Vol 189 (1) ◽  
pp. 63-68
Author(s):  
Maryam Naseri ◽  
Mohammad Shahsavan ◽  
Faeze Salahshour ◽  
Soheil Peiman ◽  
Seyed Farshad Allameh ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ct Scan ◽  
Effective Dose ◽  
Final Diagnosis ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Exposure Risk ◽  
Cross Sectional ◽  
Higher Ed ◽  
Radiological Procedures

Abstract The extent of radiation exposure in emergency settings is not well documented; here, the corresponding effective dose (ED) is provided. In 500 patients admitted in row to the emergency department, ED was compared in patients according to complaints and their visiting physicians. Out of all, 220 patients aged 43.5 ± 22.2 years (admission: 2.0 ± 1.6 days) had at least an imaging. The main reasons for admission were trauma (10.5%) and then orthopedic problems (8.6%). EDs from CT and radiography were 1.66 ± 3.59 and 0.71 ± 1.67 mSv, respectively (from all 2.29 ± 4.12). Patients with abdominal (5.8 ± 5.2 mSv; p < 0.002) and pelvic (12.0 ± 6.3 mSv; p < 0.007) complaints received higher ED from CT and radiography and, also, patients visited by surgeons (7.94 ± 6.9 mSv). CT scan was the main source for ED to patients. Irrespective of the final diagnosis, patients with abdominopelvic complaints and those visited by surgeons are at higher exposure risk.

scholarly journals Evaluation of Chest CT Scan as a Screening and Diagnostic Tool in Trauma Patients with Coronavirus Disease 2019 (COVID-19): A Cross-Sectional Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Hossein Abdolrahimzadeh Fard ◽  
Salahaddin Mahmudi-Azer ◽  
Sepideh Sefidbakht ◽  
Pooya Iranpour ◽  
Shahram Bolandparvaz ◽  
...  
Keyword(s):  
Ct Scan ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Cross Sectional Study ◽  
Chest Ct ◽  
Trauma Patients ◽  
Ct Scanner ◽  
Sectional Study ◽  
Cross Sectional ◽  
Chest Ct Scan

Background. The lack of enough medical evidence about COVID-19 regarding optimal prevention, diagnosis, and treatment contributes negatively to the rapid increase in the number of cases globally. A chest computerized tomography (CT) scan has been introduced as the most sensitive diagnostic method. Therefore, this research aimed to examine and evaluate the chest CT  scan as a screening measure of COVID-19 in trauma patients. Methods. This cross-sectional study was conducted in Rajaee Hospital in Shiraz from February to May 2020. All patients underwent unenhanced CT with a 16-slice CT scanner. The CT scans were evaluated in a blinded manner, and the main CT scan features were described and classified into four groups according to RSNA recommendation. Subsequently, the first two Radiological Society of North America (RSNA) categories with the highest probability of COVID-19 pneumonia (i.e., typical and indeterminate) were merged into the “positive CT scan group” and those with radiologic features with the least probability of COVID-19 pneumonia into “negative CT scan group.” Results. Chest CT scan had a sensitivity of 68%, specificity of 56%, positive predictive value of 34.8%, negative predictive value of 83.7%, and accuracy of 59.3% in detecting COVID-19 among trauma patients. Moreover, for the diagnosis of COVID-19 by CT scan in asymptomatic individuals, a sensitivity of 100%, specificity of 66.7%, and negative predictive value of 100% were obtained ( p value: 0.05). Conclusion. Findings of the study indicated that the CT scan’s sensitivity and specificity is less effective in diagnosing trauma patients with COVID-19 compared with nontraumatic people.

Liver nodules after the Fontan operation: role of the computerised tomography scan

2021 ◽  
pp. 1-6
Author(s):  
Saviga Sethasathien ◽  
Suchaya Silvilairat ◽  
Rekwan Sittiwangkul ◽  
Krit Makonkawkeyoon ◽  
Yupada Pongprot ◽  
...  
Keyword(s):  
Ct Scan ◽  
Hepatic Vein ◽  
Fontan Operation ◽  
Cross Sectional Study ◽  
Fontan Patient ◽  
Cross Sectional ◽  
Liver Nodules ◽  
Non Invasive ◽  
Abdomen Ct ◽  
Upper Abdomen

Abstract Currently, there is an increasing prevalence of liver nodules in patients following the Fontan operation. The appropriate non-invasive modalities have been applied to assess a diagnosis of Fontan-associated liver disease. The aims of this study were to determine the prevalence and associated factors for the presence of liver nodules using CT scan. A cross-sectional study of 34 patients older than 15 years of age was recruited. Ultrasound upper abdomen, ultrasound liver elastography, and CT scan of the upper abdomen were performed after the Fontan operation. The median age of patients was 20 years (range 14–36 years). The median age at the Fontan operation was 7 years (range 5–17 years) and the duration after the Fontan operation was 12 years (range 4–22 years). The prevalence of liver nodules was 62% as detected by CT scans. Hepatic vein pressure in patients with liver nodules was significantly higher than in those without liver nodules. Hepatic vein pressure above 13 mmHg was a factor associated with liver nodules. There was little agreement between the ultrasound of the upper abdomen and CT scan of the upper abdomen in the evaluation of liver nodules. Hepatic pressure was the only associated factor for the occurrence of liver nodules in patients following the Fontan operation. The prevalence of liver nodules was very high after the Fontan operation. The upper abdomen CT scan should be performed for the surveillance of liver nodules in every Fontan patient over the age of 15 years.

scholarly journals Head injury from falls in children younger than 6 years of age

2015 ◽  
Vol 100 (11) ◽  
pp. 1032-1037 ◽  
Author(s):  
P Burrows ◽  
L Trefan ◽  
R Houston ◽  
J Hughes ◽  
G Pearson ◽  
...  
Keyword(s):  
Head Injury ◽  
Ct Scan ◽  
Skull Fracture ◽  
Cross Sectional Study ◽  
Skull Fractures ◽  
Sectional Study ◽  
Intracranial Injury ◽  
Cross Sectional ◽  
Serious Injury ◽  
The Relationship

The risk of serious head injury (HI) from a fall in a young child is ill defined. The relationship between the object fallen from and prevalence of intracranial injury (ICI) or skull fracture is described.MethodCross-sectional study of HIs from falls in children (<6 years) admitted to UK hospitals, analysed according to the object fallen from and associated Glasgow Coma Score (GCS) or alert, voice, pain, unresponsive (AVPU) and CT scan results.ResultsOf 1775 cases ascertained (median age 18 months, 54.7% boys), 87% (1552) had a GCS=15/AVPU=alert. 19.3% (342) had a CT scan: 32% (110/342) were abnormal; equivalent to 5.9% of the overall population, 16.9% (58) had isolated skull fractures and 13.7% (47) had ICI (49% (23/47) had an associated skull fracture). The prevalence of ICI increased with neurological compromise; however, 12% of children with a GCS=15/AVPU=alert had ICI. When compared to falls from standing, falls from a person's arms (233 children (mean age 1 year)) had a significant relative OR for a skull fracture/ICI of 6.94 (95% CI 3.54 to 13.6), falls from a building (eg, window or attic) (mean age 3 years) OR 6.84 (95% CI 2.65 to 17.6) and from an infant or child product (mean age 21 months) OR 2.75 (95% CI 1.36 to 5.65).ConclusionsMost HIs from a fall in these children admitted to hospital were minor. Infants, dropped from a carer's arms, those who fell from infant products, a window, wall or from an attic had the greatest chance of ICI or skull fracture. These data inform prevention and the assessment of the likelihood of serious injury when the object fallen from is known.

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