ACUTE CALCULOUS CHOLECYSTITIS IN A YOUNG FEMALE PATIENT: A UNIQUE CASE

Acute cholecystitis needs to be rapidly diagnosed and treated correctly. The classic patient characteristics were obese, increasing age, and being female. In a few cases, cholecystitis can occured in an atypical patient, such as in young age. Here, we report a 25-year-old obese female patient that came with right upper abdominal pain which was associated with nausea and vomiting. From imaging studies, we found that she had distended gallbladder with multiple stones. Open cholecystectomy was done and patient did well postoperatively. Acute cholecystitis had to be suspected in all age, especially in patient with another risk factor like obesity in our case. Keywords: acute cholecystitis, gallstone, cholecystectomy

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Acute Calculous Cholecystitis: What is new in diagnosis and therapy?

HPB Surgery ◽

10.1155/1992/46529 ◽

1992 ◽

Vol 6 (2) ◽

pp. 69-78 ◽

Cited By ~ 8

Author(s):

Dirk J. Gouma ◽

Huug Obertop

Keyword(s):

Acute Cholecystitis ◽

Ultrasound Guidance ◽

Gallbladder Wall ◽

Percutaneous Cholecystostomy ◽

Endoscopic Retrograde ◽

Extensive Experience ◽

Acute Calculous Cholecystitis ◽

First Choice ◽

Prospective Trials ◽

Calculous Cholecystitis

The management of patients with acute calculous cholecystitis has changed during recent years. The etiology of acute cholecystitis is still not fully understood. Infection of bile is relatively unimportant since bile and gallbladder wall cultures are sterile in many patients with acute cholecystitis. Ultrasonography is first choice for diagnosis of acute cholecystitis and cholescintigraphy is second best. Percutaneous puncture of the gallbladder that can be used for therapeutic drainage has also diagnostic qualities. Early cholecystectomy under antibiotic prophylaxis is the treatment of choice, and has been shown to be superior to delayed surgery in several prospective trials. Mortality can be as low as 0.5% in patients younger than 70–80 years of age, but a high mortality has been reported in octogenerians. Selective intraoperative cholangiography is now generally accepted and no advantage of routine cholangiography was shown in clinical trials. Percutaneous cholecystostomy can be successfully performed under ultrasound guidance and has a place in the treatment of severely ill patients with acute cholecystitis. Laparoscopic cholecystectomy can be done safely in patients with acute cholecystitis, but extensive experience with this technique is necessary. Endoscopic retrograde drainage of the gallbladder by introduction of a catheter in the cystic duct is feasible but data are still scarce.

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Massive splenic infarction in a patient with acute calculous cholecystitis: a case report and literature review

International Surgery Journal ◽

10.18203/2349-2902.isj20193352 ◽

2019 ◽

Vol 6 (8) ◽

pp. 2976

Author(s):

Alaa Sedik ◽

Ahmed Fathi ◽

Mufid Maali ◽

Salwa Elhoushy ◽

Shima Morsy

Keyword(s):

Acute Abdominal Pain ◽

Open Cholecystectomy ◽

Good Condition ◽

Splenic Abscess ◽

Splenic Infarction ◽

Uneventful Recovery ◽

Quadrant Pain ◽

Acute Calculous Cholecystitis ◽

Calculous Cholecystitis ◽

Symptoms And Signs

Massive splenic infarction (MSI) is a rare cause of acute abdominal pain and is attributed to compromised blood flow to more than half of the spleen. It may be due to hematological, non-hematological, or rarely spontaneous. Symptoms and signs are non-specific. Diagnosis is based mainly on radiological investigations. The treatment is splenectomy if complications occur. We reported a case of a 50-year-Saudi lady, who was presented with a picture of acute calculous cholecystitis that was treated conservatively. Then 48 hours later, pain improved significantly, then shortly she suddenly developed a left upper quadrant pain. Computerized tomography of the abdomen diagnosed the situation as MSI. She underwent open cholecystectomy and splenectomy as conservative treatment failed and she developed a splenic abscess. She made uneventful recovery and discharged in a good condition. Hematological, cardiology, and rheumatology services diagnosed the situation as a spontaneous MSI. She was seen in surgery outpatient free of complaints.

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RESULTS OF EARLY AND DELAYED LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH AN ACUTE CALCULUS CHOLECYSTITIS AND ISCHEMIC HEART DISEASE

Medical Science of Ukraine (MSU) ◽

10.32345/2664-4738.3-4.2017.03 ◽

2018 ◽

Vol 13 (3-4) ◽

pp. 15-21

Author(s):

V.G. Mishalov ◽

S.O. Kondratenko ◽

L.Yu. Markulan

Keyword(s):

Heart Disease ◽

Laparoscopic Cholecystectomy ◽

Ischemic Heart Disease ◽

Open Cholecystectomy ◽

Group Versus ◽

Ischemic Heart ◽

Acute Calculous Cholecystitis ◽

Delayed Laparoscopic Cholecystectomy ◽

Conversion To Open Cholecystectomy ◽

Calculous Cholecystitis

Relevance. Determination of the optimal time for laparoscopic cholecystectomy (LCE) in patients with acute calculous cholecystitis (ACC) and ischemic heart disease (IHD) is still an actual and unresolved issue. Objective: to evaluate the results early versus delayed LCE in patients with ACC and IHD. Materials and methods. The study involved 107 patients with ACC and IHD: 56 (47,7 %) women and 51 (52,3 %) men aged 55 to 82 years, an average 70,2±0,6 years. The group with early LCE (ELCE) included 48 patients with LCE – up to 72 hours from the beginning of ACC (on average 41,9±2,1 hours), the group with delayed LCE (DLCE) – 59 patients, who were LCE for more than 72 hours (in average 90,2±1,6 hours) from the beginning of ACC. Groups of patients were representative according to the functional classes of heart failure, angina pectoris, severity and the histological form of ACC. All patients had a Charlson comorbidity index from 0 to 2 points. The endpoint of the study were: the frequency of conversion to open cholecystectomy, cardiac events in the intra – and early postoperative periods, the incidence of complications according to the Clavien-Dindo classification. Data analysis was performed using IBM SPSS Statistics. Results. The duration of LCE in the DLCE group was 45,2±2,1 minutes, in the ELCE group it was 40,9±1,4 min (p=0,115). Conversion to open cholecystectomy was required in 8 (13,6 %) patients of the DLCE group versus one (2,1 %) in the ELCE group, p=0,033. During the operation, myocardial ischemia occurred in 17 (28,8 %) patients of the DLCE group versus 6 (12,5%) the ELCE group, p=0,041, and a systolic blood pressure decrement lower than 70 mm hg. art. – in 24 (40,7 %) against 8 (16,7 %), p=0,007; saturation reduction episodes – in 33 (55,9 %) against 17 (35,4 %), p=0,034, respectively. In the early postoperative period, an increasing of HF class according to NYHA was observed in 12 (20,3 %) patients of the DLCE group versus one (2,1 %) in the ELCE group, p=0.004; the number of patients with complications according to Clavien-Dindo classification – 40 (67,8 %) versus 23 (47,9 %), p=0,038; pneumonia occurred in 26 (44,1 %) against 6 (12,5 %), p=0,001; exudative pleurisy – in 28 (47,5 %) against 9 (18,8 %), p=0,002, respectively. There were no lethal cases in the period up to 7 days in both groups. Conclusion. ELCE is a priority method of treatment patients with an acute calculous cholecystitis (ACC) and ischemic heart disease (IHD) with a different functional class (according to NYHA). Compared with DLCE, it is associated with reliable reduce of conversion (2,1 %), against 8 (13,6 %), intra- and early postoperative complications of the cardiovascular system and complications according to Clavien-Dindo classification – 23 (47,9 %) patients against 40 (67,8 %).

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Significance of Preoperative Ultrasound Measurement of Gallbladder Wall Thickness

The American Surgeon ◽

10.1177/000313480707300922 ◽

2007 ◽

Vol 73 (9) ◽

pp. 926-929 ◽

Cited By ~ 1

Author(s):

James Majeski

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Wall Thickness ◽

Open Cholecystectomy ◽

Acalculous Cholecystitis ◽

Gallbladder Wall ◽

Chronic Cholecystitis ◽

Entire Series ◽

Calculous Cholecystitis ◽

Gallbladder Ultrasound

Evaluation of patients with signs and symptoms of biliary tract disease usually includes ultrasound assessment of the gallbladder. Does measurement of the thickness of the gallbladder wall yield any significant information to the clinical surgeon? The records of all my patients undergoing cholecystectomy since 1990 were reviewed. The entire series consists of 401 consecutive patients, in whom 388 procedures were completed laparoscopically, with 14 patients requiring conversion to an open cholecystectomy. Each patient's preoperative evaluation included a gallbladder ultrasound, which included measurement of the diameter of the gallbladder wall. The entire series of cholecystectomies was evaluated according to the ultrasound measured diameter of the gallbladder wall. A thin gallbladder wall was less than 3 mm in diameter. A thick gallbladder wall was 3 mm or greater in diameter. Of the 401 consecutive patients who underwent cholecystectomy for symptomatic gallbladder disease, 86 (21.5%) were removed laparoscopically for acalculous disease. Eleven per cent of patients with acalculous cholecystitis had acute cholecystitis and 89 per cent had chronic cholecystitis. Every patient with either a thin or thick gallbladder wall with acalculous cholecystitis had a successful laparoscopic cholecystectomy. Three-hundred fifteen patients had a laparoscopic cholecystectomy for calculous cholecystitis. In patients with calculous cholecystitis, 28.3 per cent had acute cholecystitis and 71.7 per cent had chronic cholecystitis. The gallbladder wall was found to be greater than 3 mm in 38 per cent of patients with acute calculous cholecystitis and greater than 3 mm in 41 per cent of patients with chronic calculous cholecystitis. One-hundred, forty-two patients, out of a series total of 401, had a gallbladder wall thickness greater than 3 mm by preoperative sonography and 14 of these patients (10%) required conversion to an open cholecystectomy. A preoperative gallbladder ultrasound evaluation for symptomatic cholecystitis, which documents a thick gallbladder wall (≥3 mm) with calculi, is a clinical warning for the laparoscopic surgeon of the potential for a difficult laparoscopic cholecystectomy procedure which may require conversion to an open cholecystectomy procedure.

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Classification of acute cholecystitis:etiopathogenetic principles of construction

Herald of Pancreatic Club ◽

10.33149/vkp.2019.03.08 ◽

2019 ◽

Vol 44 (3) ◽

pp. 70-78

Author(s):

V. I. Mamchich ◽

M. A. Chaika

Keyword(s):

Acute Cholecystitis ◽

Gallstone Ileus ◽

Stress Factors ◽

Acute Calculous Cholecystitis ◽

Endovascular Interventions ◽

Care Workers ◽

Surgical Tactics ◽

Almost All ◽

Calculous Cholecystitis

Aim of study is to suggest a scientifically based pathogenetic classification of acute cholecystitis, corresponding to the classical R. Virchow triad “etiology, pathogenesis, outcome”. Materials and methods.Comparative assessment of the classical classifications by H. Kehr (1907), L. Aschoff (1909), S. P. Fedorov (1934) and modern disease schemes, combining the signs of the three ones, is conducted. Results and discussion.The proposed improved classification of acute cholecystitis (AC) corresponds to research principles, taking into account the etiology, pathogenesis and predicted outcome of the disease. There are 4 groups of AC variants: I — Acute calculous cholecystitis with all options and combinations (cholangitis, choledocholithiasis, Opie syndrome — papillary ileus, Mirizzi syndrome, Bouveres — acute gallstone ileus, hemobilia (80–85%)). II — Acute non-calculous cholecystitis without stones (8–15%) — no obstruction of the cystic duct of the gallbladder. III —Special AC forms. The dominant factors are enzymatic, vascular, non-productive anaerobic microflora, stress factors (severe injury, burns or surgery, childbirth). These forms require urgent surgeries and occur in 2–15% of all cases of AC destructive forms. IV — Специфические формы ОХ.Specific AC forms. Caused by specific microflora: typhoid, salmonella, dysentery, and parasitic (opisthorchosis, alveococcosis, amebiasis, ascariasis, less often — giardiasis). Rare forms are characteristic of endemic zones and in violation of generally accepted sanitary standards. Conclusion.Use of ultrasound, CT, SCT, MRI, endoscopic and endovascular interventions allows to diagnose almost all the AC various forms in the pre-operative period and individualize therapeutic and surgical tactics by taking into account the possible outcome. The proposed pathogenetic classification of AC can serve as a scheme for general practitioners, physicians, surgeons, anesthesiologists, and intensive care workers.

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Acute cholecystitis: predictive clinico-radiological assessment for conversion of laparoscopic cholecystectomy

Acta Radiologica ◽

10.1177/0284185120906658 ◽

2020 ◽

Vol 61 (11) ◽

pp. 1452-1462

Author(s):

Young Rock Jang ◽

Su Joa Ahn ◽

Seung Joon Choi ◽

Ki Hyun Lee ◽

Yeon Ho Park ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Abdominal Surgery ◽

Prothrombin Time ◽

Open Cholecystectomy ◽

Gallbladder Wall ◽

Acute Calculous Cholecystitis ◽

Prolonged Prothrombin Time ◽

Ct Findings ◽

History Of ◽

Calculous Cholecystitis

Background Previous studies evaluating predictive factors for the conversion from laparoscopic to open cholecystectomy have reported conflicting conclusions. Purpose To create a risk assessment model to predict the conversion from laparoscopic to open cholecystectomy in patients with acute calculous cholecystitis. Material and Methods A retrospective review of patients with acute calculous cholecystitis with available preoperative contrast-enhanced computed tomography (CT) findings who underwent laparoscopic cholecystectomy was performed. Forty-four parameters—including demographics, clinical history, laboratory data, and CT findings—were analyzed. Results Among the included 581 patients, conversion occurred in 113 (19%) cases. Multivariate analysis identified obesity (odd ratio [OR] 2.58, P = 0.04), history of abdominal surgery (OR 1.78, P = 0.03), and prolonged prothrombin time (OR 1.98, P = 0.03) as predictors of conversion. In preoperative CT findings, the absence of gallbladder wall enhancement (OR 3.15, P = 0.03), presence of a gallstone in the gallbladder infundibulum (OR 2.11, P = 0.04), and inflammation of the hepatic pedicle (OR 1.71, P = 0.04) were associated with conversion. Inter-observer agreement for CT study interpretation was very good (range 0.81–1.00). A model was created to calculate the risk for conversion, with an area under the receiver operating characteristic curve of 0.87. The risk for conversion, estimated based on the number of factors identified, was in the range of 5.3% (with one factor) to 86.4% (with six factors). Conclusion Obesity, history of abdominal surgery, prolonged prothrombin time, absence of gallbladder wall enhancement, presence of a gallstone in the gallbladder infundibulum, and inflammation of the hepatic pedicle are associated with conversion of laparoscopic to open cholecystectomy.

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Torsion of Hydrosalpinx with Concurrent Acute Cholecystitis: Case Report and Review of Literature

Case Reports in Surgery ◽

10.1155/2016/5424092 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Preeti R. John ◽

Amelia M. Pasley

Keyword(s):

Abdominal Pain ◽

Acute Cholecystitis ◽

Fallopian Tube ◽

Bladder Wall ◽

Age Groups ◽

Lower Abdominal Pain ◽

Abdominal Ultrasound ◽

Acute Calculous Cholecystitis ◽

Upper Abdominal ◽

The Right

Introduction.Isolated torsion of the Fallopian tube is an uncommon cause of acute lower abdominal pain and can occur in women of all age groups. Cholecystitis is a frequent cause of upper abdominal pain. We present an unusual case with the presence of these two distinct pathological entities occurring concurrently in the same patient, causing simultaneously occurring symptoms. To our knowledge, this is the first reported presentation of such a case.Methods.We describe a 34-year-old premenopausal woman who presented with right sided upper and lower abdominal pain and nausea. Abdominal ultrasound (US) revealed acute cholecystitis. Vaginal US was suggestive of right hydrosalpinx. Intravenous antibiotics were administered and consent was obtained for operative intervention. During laparoscopy, the right Fallopian tube with hydrosalpinx was noted to be twisted three times. The right ovary appeared normal. The gall bladder wall was thickened and inflamed. Laparoscopic right salpingectomy and cholecystectomy were performed.Results.Surgical pathology revealed hydrosalpinx with torsion and acute calculous cholecystitis. The patient had an uneventful postoperative course and was discharged home on the first postoperative day. Her symptoms resolved after the procedure.Conclusions.In women with abdominal pain, both gynecologic and nongynecologic etiologies should be considered in the differential diagnoses. Concurrent presence of symptomatic gynecologic and nongynecologic intra-abdominal pathology is rare. Isolated Fallopian tube torsion is rare and is associated most often with hydrosalpinx. Some torqued Fallopian tubes can be salvaged. Laparoscopy is useful in management of both Fallopian tube torsion and cholecystitis.

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Primary Hepatic Lymphoma Presenting as an Acute Abdomen in a Young Female Patient: A Case Report and Literature Review

Case Reports in Surgery ◽

10.1155/2019/6784325 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Walid E. Abdelrahim ◽

Kamal E. Mohamed ◽

Salwa O. Mekki ◽

Eltaib A. Saad

Keyword(s):

Female Patient ◽

B Cell Lymphoma ◽

Young Female ◽

Left Lobe ◽

Resection Margins ◽

Surgical Biopsy ◽

Primary Hepatic Lymphoma ◽

Contrast Enhanced ◽

Upper Abdominal ◽

Enhanced Computed Tomography

We report a rare case of primary hepatic lymphoma (PHL) in a hepatitis B virus- (HBV-) infected young female patient who presented with right upper abdominal pain, nausea, and vomiting for a few days. The preoperative diagnosis was difficult due to the rarity of the disease and the presence of a solitary hypodense mass in the left lobe of the liver on contrast-enhanced computed tomography (CT) scan with a normal alpha-fetoprotein (AFP) and negative cytology. She underwent an uneventful extended left hemihepatectomy, and the surgical biopsy revealed a PHL—of diffuse large B-cell lymphoma (DLBCL) type—with negative resection margins. She received adjuvant combination chemotherapy and remained disease-free with normal serial radiology over a 2-year follow-up period.

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Evaluation of Preoperative Risk Factors for Converting Laparoscopic to Open Cholecystectomy

The American Surgeon ◽

10.1177/000313481207800815 ◽

2012 ◽

Vol 78 (8) ◽

pp. 831-833 ◽

Cited By ~ 8

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.

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FEATURES OF SURGICAL TACTICS OF TREATMENT OF ACUTE CALCULOUS CHOLECYSTITIS OCCURRING AGAINST THE BACKGROUND OF DIABETES MELLITUS

Kuban Scientific Medical Bulletin ◽

10.25207/1608-6228-2018-25-6-90-95 ◽

2018 ◽

Vol 25 (6) ◽

pp. 90-95

Author(s):

V. V. Zorik ◽

G. K. Karipidi ◽

A. V. Morozov

Keyword(s):

Diabetes Mellitus ◽

Laparoscopic Cholecystectomy ◽

Surgical Treatment ◽

Postoperative Complications ◽

Histological Study ◽

Open Cholecystectomy ◽

Control Group ◽

Acute Calculous Cholecystitis ◽

Patients With Diabetes ◽

Calculous Cholecystitis

Aim. The study was conducted to improve the results of the surgical treatment of acute calculous cholecystitis occurring against the background of diabetes mellitus. Materials and methods. In course of our study, we analyzed the treatment results of 687 patients with acute calculous cholecystitis. Depending on the presence of diabetes, all patients were divided into two groups. The main group with concomitant diabetes mellitus included 68 (9,9%) patients, whereas the control group without diabetes included 619 (90,1%) patients. Laparoscopic cholecystectomy was performed on 636 (92,6%) patients, and open cholecystectomy was performed on 51 (7,4%) patients. Results. According to the histological study, the greatest number of destructive forms occurs in patients with concomitant diabetes, operated after 24 hours. The least postoperative complications occur in patients of both groups operated from 12 to 24 hours. However, the incidence of complications is 4-5 times higher in patients with diabetes mellitus. Postoperative complications in patients with acute calculous cholecystitis occurring on the background of sugar diabetes were observed after open cholecystectomy in 33,3% of cases and in 6,5% of cases after laparoscopic surgery.Conclusion In patients with acute cholecystitis and concomitant diabetes, surgical treatment should be performed on the first day after the preoperative preparation during the first 12 hours, aimed at compensating for diabetes and improving microcirculation. The preference should be given to laparoscopic cholecystectomy, which reduces the number of postoperative complications by 5 times and mortality by 4.5 times.

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