scholarly journals Laparoscopic Cholecystectomy for Large/Giant Gallstones: Case Report and Brief Review of Literature.

2021 ◽  
Author(s):  
Anup Shrestha ◽  
Shachee Bhattarai ◽  
Shreya Shrestha ◽  
Manoj Chand ◽  
Abhishek Bhattarai
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Case Report ◽  
Open Cholecystectomy ◽  
Umbilical Incision ◽  
Post Operative Period ◽  
Laparoscopic Equipment ◽  
Asymptomatic Patients ◽  
History Of ◽  
Normal Gallbladder ◽  
Colicky Pain

Abstract Background Gallstones disease (GSD) is the most common biliary pathology. GSD is one of the common surgical problems in which lead people admit to the hospital in Nepal. Its prevalence is found to be 4.87%. The size of a gallstone is important, as giant/large gallstones have a higher risk of complications and present technical difficulties during laparoscopic cholecystectomy (LC). Open cholecystectomy is preferred in most cases with giant gallstones. With the availability of experienced laparoscopic surgeons and modern laparoscopic equipment LC is also feasible in large/giant gallstones. In this case report, we report 2 cases of one large and one giant gallstone each which were successfully done laparoscopically.Case Presentation Case 1 A 51 years old female presented with 5 months history of intermittent right upper quadrant colicky pain related to fatty food with no significant past medical and surgical history.Ultrasound abdomen showed normal gallbladder with multiple gallstones, largest measuring approximately 4cms. She was planned for elective LC. The gallbladder was removed out after extension of the infra-umbilical incision. On the cut section, we found multiple gallstones with one large gallstone measuring 4*3.3*3 cm and weighted 23.2 gm. Her post-operative period was uneventful. Case 2 A 39 years old female, known case of hypertension under calcium channel blocker(CCB) and angiotensin receptor blocker(ARBs) presented with 5 months history of intermittent right upper quadrant colicky pain related to fatty foods with non-significant surgical history. Ultrasound abdomen showed a normal gallbladder with a single large gallstone (approximately 4.7 cm). Elective LC was performed and the gallbladder was removed out after extension of infraumbilical incision. On the cut section, we found a single giant gallstone measuring 5* 3*2.8 cm and weighted 24.7 gm. Her post-operative period was uneventful.Conclusion Large/giant gallstones are associated with a high risk of complications and cholecystectomy is warranted in symptomatic and asymptomatic patients. Even for large/giant gallstones, LC appears to be the treatment of choice over open cholecystectomy and should be performed by an experienced laparoscopic surgeon, taking into consideration the possibility of conversion to open in case of inability to expose the anatomy and any intraoperative technical difficulties.

scholarly journals Laparoscopic Cholecystectomy for Large/Giant Gallstones: Case Report and Brief Review of Literature

2021 ◽  
Vol 2 (2) ◽  
pp. 87-90
Author(s):  
Anup Shrestha ◽  
Shachee Bhattarai ◽  
Shreya Shrestha ◽  
Manoj Chand ◽  
Abhishek Bhattarai
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Case Report ◽  
Open Cholecystectomy ◽  
Review Of Literature ◽  
Post Operative Period ◽  
Laparoscopic Equipment ◽  
Biliary Pathology

Gallstones disease are the most common biliary pathology. Its prevalence in Nepal is found to be 4.87%. Giant/large gallstones have a higher risk of complications and presents technical difficulties during laparoscopic cholecystectomy. Open cholecystectomy is preferred in most of the cases with giant gallstones. With the availability of experience laparoscopic surgeon and modern laparoscopic equipment, laparoscopic cholecystectomy is also feasible in large/giant gallstones. We report 2 cases, one large gallstone in 51 years old female and one giant gallstone in 39 years old female each of which were successfully managed laparoscopically with uneventful post-operative period.

scholarly journals Incidental Finding of Posterior Fossa Epidermoid, In a Head Trauma Patient: A Case Report

2019 ◽  
Vol 17 (1) ◽  
pp. 56-57
Author(s):  
Narendra Prasad Baskota ◽  
K. Singh
Keyword(s):  
Case Report ◽  
Head Injury ◽  
Posterior Fossa ◽  
Head Trauma ◽  
Incidental Findings ◽  
Incidental Finding ◽  
Brain Lesions ◽  
Minor Head Trauma ◽  
Post Operative Period ◽  
History Of

Incidental findings of brain lesions in head injury are seen frequently. In our region NCC is common, but in literature meningioma andarachnoid cyst are common. Here we report a case of incidental finding of posterior fossa epidermoid in a 25 years old male patient who had history of minor head trauma which was operated with relatively uneventful post operative period.

scholarly journals Occult insulinoma after oesophagectomy for oesophageal cancer-diagnostic challenges

2021 ◽  
Vol 9 (1) ◽  
pp. 185
Author(s):  
Marta Alexandre Silva ◽  
Maria João Amaral ◽  
Pedro Pinto ◽  
Mónica Martins ◽  
Marco Serôdio ◽  
...  
Keyword(s):  
Case Report ◽  
Male Patient ◽  
Clinical Case ◽  
Gastrointestinal Surgery ◽  
Gastric Surgery ◽  
Diagnostic Investigation ◽  
Post Operative Period ◽  
History Of ◽  
Oesophageal Surgery ◽  
Hyperinsulinemic Hypoglycaemia

Hypoglycaemia in the post-operative period is mainly iatrogenic (related to anti-hyperglycaemic drugs), but can be explained by an endogenous hyperinsulinemic state. In the context of previous gastrointestinal surgery, a form of dumping syndrome can mask hypoglycaemia from an underlying cause, such as an insulinoma. The authors present a clinical case of a male patient who underwent oesophageal surgery for an oesophago-gastric junction adenocarcinoma and developed hypoglycaemic symptoms in the post-operative period, caused by an undiagnosed insulinoma. This case report portraits the diagnostic investigation of a hypoglycaemia state in the post-operative period, narrowing to the workup of an endogenous hyperinsulinemic hypoglycaemia and provides a summary of insulinoma’s treatment. An insulinoma should always be considered in a patient with endogenous hyperinsulinemic hypoglycaemia, even with a history of oesophago-gastric surgery.

scholarly journals Acute cholecystitis with Cholecystocolic fistula: a case report and pertinent literature review

2017 ◽  
Vol 4 (8) ◽  
pp. 2823
Author(s):  
Mansur S. Alqunai ◽  
Mahmoud Abdul-Kareem Daif-Allah ◽  
Loai Alhammad3
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Case Report ◽  
Late Complication ◽  
Single Test ◽  
Patient History ◽  
Pertinent Literature ◽  
Asymptomatic Patients ◽  
Radiological Data ◽  
Low Sensitivity ◽  
Cholecystocolic Fistula

Cholecystocolic fistula (CCF) is a rare late complication of gallstones. The clinical features of CCF are nonspecific and variable. No single test is sufficient to diagnose CCF because of the low sensitivity of the tests or the invasive nature of the procedures, and these tests are not routinely requested for asymptomatic patients. Because CCF is rarely diagnosed preoperatively, patient history, laboratory, and radiological data play an important role in alerting surgeons to the possible existence of a CCF. Treatment involves closing the fistula and performing an open or laparoscopic cholecystectomy.

scholarly journals Risk factors for the conversion of laparoscopic to open cholecystectomy

2018 ◽  
Vol 5 (7) ◽  
pp. 2470
Author(s):  
Kiran Kumar Paidipelly ◽  
Sangamitra .
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Open Surgery ◽  
Open Cholecystectomy ◽  
Previous History ◽  
Normal Activity ◽  
Post Surgery ◽  
History Of ◽  
The Right ◽  
Hospital Days ◽  
Lower Morbidity

Background: Gall stones is one of the most common diseases in man. Laparoscopic cholecystectomy is the preferred procedure, mainly due to lower morbidity and mortality, thus returning to the normal activity sooner, lesser number of hospital days and lesser pain post-surgery. However, around 2-15% of the patients need to convert from laparoscopic to open surgery due to different reasons.Methods: 357 patients who came in for laparoscopic cholecystectomy were included into the study. Details such as age, height, weight, BMI, mode of surgery i.e. emergency or elective, physical and clinical examination including Ultrasound, lab results, previous history of surgery and other co morbidities were noted.Results: Out of the 357 patients, 31(8.7%) were converted to open cholecystectomies, of which, 61.3% females and 38.7% males. 58% in the open cholecystectomy group were above 60 years. 67.7% of the patients who converted to open surgery had a BMI of over 25, while it was 39.6%   in case of laparoscopic surgery. 74.2% among the patients who had undergone conversion to the open surgery had pain in the right hypochondrium, 67.7% had increased WBC levels.Conclusions: Increased age, obesity, tenderness in the RHC, increased WBC levels, acute cholecystitis are the predisposing factors for the conversion of laparoscopic cholecystectomy to open cystectomy.

scholarly journals P-BN21 Diagnostic accuracy of transabdominal ultrasound for assessing gallbladder polyps

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
John Young ◽  
Anas Belhasan ◽  
Nisheeth Kansal ◽  
Sanjay Taribagil
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Retrospective Study ◽  
Chronic Cholecystitis ◽  
Malignant Potential ◽  
Transabdominal Ultrasound ◽  
Gallbladder Polyps ◽  
Asymptomatic Patients ◽  
Normal Gallbladder ◽  
Pathology Reports ◽  
Current Guidelines

Abstract Background Gallbladder polyps are common findings on transabdominal ultrasound (TAUS) and their implications are not entirely clear. Current guidelines advise monitoring with serial TAUS and to offer laparoscopic cholecystectomy if criteria are met to minimise risk of malignant transformation. TAUS is easily accessible and useful at identifying gallbladder polyps, however, has limitations when differentiating between pseudopolyps and true gallbladder polyps with malignant potential. This study looks at a district general hospital’s outcomes for patients undergoing laparoscopic cholecystectomy for gallbladder polyps. Methods This retrospective study identified patients who had polyps identified on TAUS and subsequently undergone laparoscopic cholecystectomy from 2011 to 2021. We identified patients using hospital coding and subsequently assessed their pre-operative imaging and clinic letters to ensure gallbladder polyps were the reason for cholecystectomy. The size of polyp on TAUS was noted and pathology reports were assessed to determine if polyps had been correctly identified on TAUS and if these were true or pseudopolyps. Clinic letters were assessed to determine if patients were symptomatic pre-operatively. Results 66 patients were identified as having polyps pre-operatively. The size of polyp ranged from 2-19mm with a mean of 7.4mm. 39 (59%) patients were symptomatic pre-operatively. TAUS findings correlated with pathology findings of polyps in 45 (68%) patients. Of the 21 patients with no polyps on pathology: 11 had gallstones, 9 had chronic cholecystitis and 1 normal gallbladder. Of the polyps identified 44 were pseudopolyps and only 1 was a true adenoma – 39 cholesterol polyps, 3 inflammatory polyps and 2 adenomyomatosis. There was no evidence of dysplasia on the adenoma, it measured 5mm on TAUS and the patient was symptomatic. Conclusions This study highlights the limitations of TAUS in correctly identifying true polyps. The 41% of asymptomatic patients all had benign findings on pathology and likely had no benefit from surgery. Whilst TAUS is a useful method of identifying potential polyps these findings would suggest that other methods of identifying true polyps should be sought to minimise patients undergoing unnecessary surgery.  

Unfused Liver Segments: a Case Report of an Unknown Phenotype of the Conradi-Hünermann-Happle Syndrome

2016 ◽  
Vol 25 (4) ◽  
pp. 547-549 ◽  
Author(s):  
Fabian Bartsch ◽  
Maximilian Ackermann ◽  
Hauke Lang ◽  
Stefan Heinrich
Keyword(s):  
Magnetic Resonance Imaging ◽  
Laparoscopic Cholecystectomy ◽  
Case Report ◽  
Magnetic Resonance ◽  
Binding Protein ◽  
Genetic Disorder ◽  
Open Cholecystectomy ◽  
Chondrodysplasia Punctata ◽  
Resonance Imaging ◽  
Anatomical Variant

Background: Since its description in 1957, Couinaud`s classification of the segmental organization of the liver has remained valid. However, recent investigations by 3-dimensional computed tomography suggest a significant variability of the vascular anatomy and segment volume. Here, we report a surprise finding during the laparoscopic cholecystectomy of a patient with Conradi-Hünermann-Happle syndrome, in whom the liver segments were not fused. Case report: Laparoscopic cholecystectomy was performed because of recurrent biliary pancreatitis in a 47 year-old male patient, who had been diagnosed with Conradi-Hünermann-Happle syndrome. Upon direct view, the liver parenchyma appeared normal, but liver segments were separated and connected by fibrous bridges containing vascular structures, only. Since the hilar anatomy was unclear, an open cholecystectomy was performed without technical difficulties and the postoperative course was uneventful. Postoperatively, magnetic resonance imaging was performed, which revealed a trifurcation of the portal vein and a right bile duct draining into the left main duct. Intersegmental signal alterations corresponded to the fibrous bands seen during laparoscopy. Conclusions: The intraoperative findings of this case confirm the segmental organization of hepatic anatomy proposed by Couinaud. The first description of such an unusual anatomical variant in an extremely rare genetic disorder strongly suggests an association with the genetic background of the syndrome. The established abnormalities of cholesterol biosynthesis in patients with Conradi-Hünermann-Happle syndrome may well explain the observed liver anomaly, which is a novel phenotype of this syndrome. Based on this case, we suggest a potential involvement of the mutation in the emopamil-binding protein gene in liver development and regeneration. Abbreviations: CDPX2: X-linked dominant chondrodysplasia punctata; EPB: emopamil-binding protein; MRCP: magnetic resonance cholangiopancreatography; MRI: magnetic resonance imaging; RCDP: rhizomelic chondrodysplasia punctuata.

scholarly journals Calcific Myonecrosis of the Leg: A Case Report

2019 ◽  
Vol 2 (1-3) ◽  
pp. 47-53
Author(s):  
Kewal Gangrade ◽  
Girish Yeotikar ◽  
Arjun Wadhwani ◽  
Vinod Naneria
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Compartment Syndrome ◽  
Muscle Mass ◽  
Rare Presentation ◽  
Complete Excision ◽  
Radiological Features ◽  
Calcific Myonecrosis ◽  
Asymptomatic Patients ◽  
History Of

Calcific myonecrosis is characterized by central liquefaction and peripheral calcification involving the entire muscle mass and is considered to be a late sequel of compartment syndrome. Being a rare presentation, considering differential diagnosis is important. Diagnosis is based on history of trauma and typical radiological features. Symptomatic patients require complete excision of the mass while asymptomatic patients can be treated nonoperatively.

scholarly journals Pre-operative predictors of difficult laparoscopic cholecystectomy and its correlation with post-cholecystectomy syndrome and its impact on quality of life in North Indian population

2021 ◽  
Author(s):  
Priyanka Agrawal ◽  
Mahboob Alam ◽  
Dhirendra Pratap ◽  
Krishna K. Singh ◽  
Lokesh Gupta ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Laparoscopic Cholecystectomy ◽  
Open Cholecystectomy ◽  
Standard Technique ◽  
Prior History ◽  
Clinical Predictors ◽  
Duration Of Surgery ◽  
History Of ◽  
The Impact

Background: Laparoscopic cholecystectomy (LC) is the most preferable surgical procedure worldwide. LC is not completely risk-free and 2 to 15% of attempted LC procedures have to be converted to open cholecystectomy. The aim of the study was to assess the predictors of difficult LC procedures and for knowing the impact of difficult LC procedures on post-cholecystectomy syndrome and quality of life of patients.Methods: A prospective observational study was conducted on patients who underwent LC. Clinical, demographic, radiological and biochemical parameters along with detailed history of patients were documented. Laparoscopic cholecystectomy was then done on patients using standard technique. Level of difficulty in LC procedure was assessed and graded. Occurrence of post-cholecystectomy syndrome was investigated and quality of patient’s life was assessed using SF-36 inventory.Results: The difficulty rate in LC procedure was observed to be 17.4%. The clinical predictors of difficult LC procedures were old age and prior history of abdominal surgery. Contracted gall bladder, peripancreatic fluid and thick gallbladder wall were radiological predictors and presence of adhesions, longer duration of surgery and conversion to open procedures were intraoperative predictors of difficult LC procedures. Early PCS was affected by difficult LC procedures; though with passage of time it reduced. Post-operative quality of life was affected more by PCS incidence than the difficult LC procedure.Conclusions: The findings of the study would help in anticipating predictors of difficult LC procedures and in understanding the phenomenology and determinants of PCS along with its relationship with operative difficulty and quality of life of patients.

scholarly journals Laparoscopic cholecystectomy: Conversion rate and complcation

2016 ◽  
Vol 18 (3) ◽  
pp. 43
Author(s):  
BR Malla ◽  
HN Joshi ◽  
N Rajbhandari ◽  
YR Shakya ◽  
B Karki ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Conversion Rate ◽  
Open Cholecystectomy ◽  
Gallbladder Disease ◽  
Conversion To Open Surgery ◽  
Calot’S Triangle ◽  
Conversion Rates ◽  
Conversion To Open Cholecystectomy ◽  
Previous Laparotomy ◽  
History Of

Introduction and Objective: Laparoscopic Cholecystectomy is the standard surgical treatment for gallbladder disease. However, conversion to open surgery is not the complication. Different centers have reported different conversion rates and post operative complications. The objective of this study is to identify conversion rate and post operative complication of laparoscopic cholecystectomyMaterials and Methods: This retrospective study included all laparoscopic cholecystectomies attempted in Dhulikhel hospital during the year 2015. Files of all patients were reviewed to find out the demography of the patients and the indication of Laparoscopic cholecystectomy. The rate of conversion to open cholecystectomy, the underlying reasons for conversion and postoperative complications were analyzed.Results: Out of 324 cases attempted laparoscopic cholecystetomies, two cases with the history of previous laparotomy were excluded to rule out the bias in the result. Out of 322 cases 226(70.18%)were female and 96(29.81%) were male . The mean age was 38 years. Over all conversion rate to open cholecystetomy was 1.86% with frozen calot’s triangle as the most common reason for conversion. The over all postoperative complication was 1.24% with no major bile duct injury.Conclusion: Laparoscopic cholecystectomy can safely be done with low conversion rate and complication.

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