Cholesterolosis of the gall bladder: a surgical dilemma

Cholesterolosis of the gall bladder or cholesterol polyps of the gall bladder have always been a contentious issue with respect to the role of prophylactic surgery in view of its asymptomatic state. Symptomatic cholesterol polyps behave similar to gall stones. There is therefore a need for a surgical algorithm to manage these lesions. A case of symptomatic cholesterol polyps of the gall bladder is reported to highlight the clinical presentation, imaging modalities and management strategies. Symptomatic cholesterol polyps of the gall bladder necessitate cholecystectomy. However, surgical intervention for asymptomatic polyps is guided by their size. Increased diameter is highly suspicious of a malignant potential requiring pre-operative staging and radical surgery.

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T2 Gallbladder Cancer—Aggressive Therapy is Warranted

The American Surgeon ◽

10.1177/000313481608200612 ◽

2016 ◽

Vol 82 (6) ◽

pp. 518-521 ◽

Cited By ~ 2

Author(s):

Mohd Raashid Sheikh ◽

Houssam Osman ◽

Susannah Cheek ◽

Shenee Hunter ◽

Dhiresh Rohan Jeyarajah

Keyword(s):

Clinical Presentation ◽

Radical Surgery ◽

Radical Resection ◽

Gall Bladder Cancer ◽

Incidental Diagnosis ◽

Radical Cholecystectomy ◽

Node Positive ◽

Operative Findings ◽

Worse Prognosis

Treatment of gall bladder cancer (GBC) has traditionally been viewed with pessimism and lymph node positivity has been associated with worse prognosis. The aim of this study is to analyze the role of radical cholecystectomy in T2 tumors. All patients who underwent surgery for GBC between September 2005 and June 2014 were identified retrospectively. Data collected included clinical presentation, operative findings, and histopathological data. Twenty-five patients had incidental GBC diagnosis after cholecystectomy. Ten patients were T2 on initial cholecystectomy pathology and all underwent radical resection. Two patients were N1 on initial cholecystectomy pathology. Four were upstaged to N1 and two patients were upstaged to T3 after further surgery. Overall, 60 per cent patients with T2 disease had node positivity and 60 per cent were upstaged by further surgery. Eleven patients were diagnosed on imaging. Four of these patients were unresectable and six were either stage T3 or higher or node positive. Sixty per cent of T2 GBC was node positive and 60 per cent were upstaged with radical cholecystectomy. This finding supports the call for radical resection in patients with incidental diagnosis of T2 tumor on cholecystectomy. This study also emphasizes the role of radical surgery in accurate T staging.

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Parathyroid Cancer: A Review

Cancers ◽

10.3390/cancers11111676 ◽

2019 ◽

Vol 11 (11) ◽

pp. 1676 ◽

Cited By ~ 5

Author(s):

Machado ◽

Wilhelm

Keyword(s):

Clinical Presentation ◽

Surgical Intervention ◽

Disease Process ◽

Staging System ◽

Diagnostic Process ◽

Parathyroid Cancer ◽

En Bloc ◽

History Of ◽

General Guide

Parathyroid cancer is one of the rarest causes of primary hyperparathyroidism and tends to present with more severe symptoms than its more benign counterparts. This article details various aspects of the disease process, including epidemiology, clinical presentation, and a step-wise diagnostic process for parathyroid cancer. This includes laboratory assessments as well as a proposed staging system. The en bloc principle of surgical intervention is detailed, as well as the current role of adjuvant treatments. A general guide to surveillance and the natural history of the disease is also outlined.

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Management of Laparoscopic Sleeve Gastrectomy Staple-Line Leak

10.1093/med/9780190608347.003.0030 ◽

2018 ◽

Author(s):

Jorge A. Huaco ◽

Emanuele Lo Menzo ◽

Samuel Szomstein ◽

Raul J. Rosenthal

Keyword(s):

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Clinical Presentation ◽

Surgical Intervention ◽

Proximal Gastrectomy ◽

Hemodynamic Instability ◽

Intraluminal Pressure ◽

Complication Rates ◽

Surgical Options

Laparoscopic sleeve gastrectomy (LSG) has rapidly become the preferred procedure in bariatric surgery. Because of the increased intraluminal pressure and the presence of an intact pylorus, leaks after LSG have a tendency to perpetuate and become chronic. The management of leaks depends primarily on the clinical presentation of the patient, but a leak’s location and chronicity also play a significant role in management. In general, patients with hemodynamic instability need to be treated aggressively and expeditiously with surgical intervention, whereas more stable patients can undergo less-invasive interventions, such as percutaneous drainage and an endoscopic approach. However, once the leak becomes chronic, the role of endoscopic and percutaneous approaches is uncertain, and often more radical surgical intervention is required. Among the surgical options for chronic leaks, Roux-en-Y mucosa-to-mucosa anastomosis and proximal gastrectomy with Roux-en-Y reconstruction have delivered durable results, with acceptable complication rates.

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Role of early surgical intervention in outcome and prognosis of spontaneous cerebellar hemorrhage with intraventricular extension

Eastern Green Neurosurgery ◽

10.3126/egn.v3i01.38962 ◽

2021 ◽

Vol 3 (01) ◽

pp. 28-32

Author(s):

Jemesh Singh Maharjan

Keyword(s):

Clinical Presentation ◽

Surgical Intervention ◽

Sudden Onset ◽

Cerebellar Hemorrhage ◽

First Case ◽

Spontaneous Intracranial Hemorrhage ◽

Poor Outcomes ◽

The Right ◽

Early Surgical Intervention

Spontaneous cerebellar hematomas represent 5 to 13% of all cases of spontaneous intracranial hemorrhage. The main controversy involves deciding which cases require surgical evacuation of the hematoma versus other options, such as ventricular drainage only or conservative treatment. Furthermore, because the clinical course is variable in some cases, timing of such treatment should be carefully considered. The duration from the onset of hemorrhage also plays an important role in prognosis and recovery of the patient. Both the clinical presentation and subsequent course vary among cases. Unpredictable rapid deterioration in consciousness levels has been recognized. The majority of patients with such decline in consciousness experience the deterioration primarily within 72 hrs after onset⁠. Acute presentation was observed to be correlated with poor outcomes. In our report, the first case presented with sudden onset of headache in the right frontal region of head with vertigo. He came to hospital within 6 hours of onset. However, the second case had an onset of symptoms around 72 hours before the presentation.

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The Etiology of Gall Stones. II. Rôle of the Gall Bladder.

Annals of Internal Medicine ◽

10.7326/0003-4819-5-4-524_2 ◽

1931 ◽

Vol 5 (4) ◽

pp. 524

Keyword(s):

Gall Bladder ◽

Gall Stones

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Different outcomes of spontaneous gall bladder perforation owing to timing of surgical intervention: report of 2 cases

International Surgery Journal ◽

10.18203/2349-2902.isj20204707 ◽

2020 ◽

Vol 7 (11) ◽

pp. 3835

Author(s):

Nawaz M. Dakhani ◽

Yamanur P. Lamani

Keyword(s):

Case Report ◽

Gall Bladder ◽

Clinical Presentation ◽

Surgical Intervention ◽

Bladder Perforation ◽

Type I ◽

Delay In Diagnosis ◽

Type Iii ◽

Pain Abdomen ◽

Atypical Clinical Presentation

Gall bladder perforation (GBP) is a rare life-threatening complication with a high mortality due to atypical clinical presentation and delay in diagnosis due to atypical clinical presentation. Case report 1, 70-year-old female presented with complaints of pain abdomen, vomiting and blackish pigmentation over abdomen since a week. She was in shock on presentation, with necrotic patch over abdomen and abscess collection at umbilicus. Ultrasound revealed GBP at fundus with thick collection in gastrohepatic recess with overlying abdominal wall cellulitis. CECT was not possible and the patient could not be taken for surgery due to unstable vitals and expired the next day. Case report 2, a 68-year-old male presented with complaints of pain abdomen over right side with vomiting. Abdomen was tender diffusely with guarding in right hypochondrium. Ultrasound showed distended gall bladder (GB) with multiple calculi. Magnetic resonance cholangiopancreatography (MRCP) showed a GBP at fundus with pericholecystic collection extending into hepatogastric recess. He underwent total cholecystectomy and post-operative period was uneventful. Acute cholecystitis has a perforation rate of 2-11% due to cystic duct obstruction, ischemia and necrosis. Our first patient had type-III GBP and was in shock and did not survive due to bad condition on arrival whereas the second patient had type-I GBP and underwent cholecystectomy without any complications. Type-I and type-II GBP as proposed by Niemeier have better outcomes compared to type-III. Rapid diagnosis and surgical intervention are very much necessary for reducing mortality as they rarely present with typical signs and symptoms of perforation.

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