Gossypiboma Presenting as Coloduodenal Fistula – Report of a Rare Case With Review of Literature

Abstract The term gossypiboma is used to describe a mass of cotton matrix left behind in a body cavity intraoperatively. The most common site reported is the abdominal cavity. It can present with abscess, intestinal obstruction, malabsorption, gastrointestinal hemorrhage, and fistulas. A 37-year-old woman presented with pain in the right hypochondrium for 2 months following open cholecystectomy. As she did not improve with proton pump inhibitors, an esophagogastroduodenoscopy (EGD) was done, which showed a possible gauze piece stained with bile in the first part of the duodenum. Contrast-enhanced computed tomography (CECT) of the abdomen revealed an abnormal fistulous communication of the first part of duodenum with proximal transverse colon, with a hypodense, mottled lesion within the lumen of the proximal transverse colon plugging the fistula, suggestive of a gossypiboma. Excision of the coloduodenal fistula, primary duodenal repair, and feeding jejunostomy was done. The patient recovered well and is now tolerating normal diet. Coloduodenal fistula is usually caused by Crohn's disease, malignancy, right-sided diverticulitis, and gall stone disease. Isolated coloduodenal fistula due to gossypiboma has not been reported in the literature so far to the best of our knowledge. We report this case of coloduodenal fistula secondary to gossypiboma for its rarity and diagnostic challenge.

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Spontaneous Cholecystocutaneous Fistula: A rare clinical Entity

Polish Journal of Surgery ◽

10.5604/01.3001.0013.6277 ◽

2019 ◽

Vol 92 (5) ◽

pp. 1-5

Author(s):

Amit Gupta ◽

Manoj Joshua ◽

Navin Kumar ◽

Udit Chauhan ◽

Sweety Gupta

Keyword(s):

Gall Bladder ◽

Histopathological Examination ◽

Open Cholecystectomy ◽

Fistulous Tract ◽

Gall Stone ◽

Stone Disease ◽

Clinical Entity ◽

Rare Clinical Entity ◽

The Right ◽

Operative Recovery

Introduction: Spontaneous Cholecystocutaneous Fistula occurs as a result of complication from untreated gall bladder stone disease infrequently seen in surgical practice due to early diagnosis of gall stone disease with imaging and appropriate and prompt antibiotic and surgical treatment. Case report: We report our experience with a 40-year-old woman who presented with a yellowish discharge from the umbilicus. Abdominal examination revealed a sinus opening at the umbilicus with the yellowish discharge and a vague mass in the right hypochondrium. CT fistulogram showed tract extending form the umbilicus to the gall bladder. Open cholecystectomy with excision of the fistulous tract was carried out. Histopathological examination showed chronic inflammation of the gall bladder with the fistulous tract lined by inflammatory granulation tissue. Post-operative recovery was normal and uneventful. The patient was normal in follow-up. Cholecystocutaneous fistula is a rare clinical entity. The diagnosis is established with CT and MRCP. Surgery remains the mainstay of treatment.

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Evaluation of relationship of body mass index with severity of cholecystitis

International Surgery Journal ◽

10.18203/2349-2902.isj20190570 ◽

2019 ◽

Vol 6 (3) ◽

pp. 868 ◽

Cited By ~ 2

Author(s):

Varun V. Chauhan ◽

Bhushan A. Shah ◽

Shivaratna J. Mahadik ◽

Rohan P. Videkar

Keyword(s):

Risk Factor ◽

Open Cholecystectomy ◽

Gall Stone ◽

Stone Disease ◽

Established Risk Factor ◽

Significant Difference ◽

Conversion To Open Cholecystectomy ◽

Gall Stone Disease ◽

Total Body ◽

A Prospective Study

Background: Obesity is an established risk factor for gall stone disease. Male sex has also been recently cited as a risk factor for severe symptomatic cholelithiasis. As a possible cause of several difference in regards to the severity of cholecystitis, many physiological differences between the two sexes can be examined. Many studies have been done on the risk factors for developing the gall bladder disease explaining its polygenic nature It is postulated that the total body fat, the main value of which is significantly higher for females than males, may contribute to this sex difference. Only a couple of studies are available on BMI and its effect on severity of cholecystitis hence depicting the need for this study in our setup.Methods: This is a prospective study carried out on 70 patients for cholecystitis whose weight and height measurements had been recorded on admission. Patients were placed in either group-Obese (BMI e” 25kg/m2) or Non-Obese (BMI <25kg/m2). The association between BMI and severity of cholecystitis was investigated.Results: 18% of the laparoscopic cholecystectomy surgeries required conversion to open cholecystectomy due to reasons like severe adhesions to an adjacent organ, etc. Pain in abdomen (100%) was the commonest complaint and was present in all the patients followed by dyspepsia (44%).69% of patients were having complaints for more than 72 hours. No significant difference observed among mean BMI of different grades of severity (p=0.963).Conclusions: There is negative correlation between BMI and grade of severity of cholecystitis and BMI is not a predictor for the conversion from laparoscopic to open cholecystectomy.

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A study on clinical and radiological factors for predicting difficult laparoscopic cholecystectomy preoperatively

International Surgery Journal ◽

10.18203/2349-2902.isj20173878 ◽

2017 ◽

Vol 4 (9) ◽

pp. 3015

Author(s):

Arun Prasath S. ◽

Surag Kajoor Rathnakar ◽

Nagaraja Anekal L.

Keyword(s):

Laparoscopic Cholecystectomy ◽

Abdominal Surgery ◽

Open Cholecystectomy ◽

Fluid Collection ◽

Gall Stone ◽

Stone Disease ◽

Elderly Age ◽

Conversion To Open Cholecystectomy ◽

Upper Abdominal ◽

A Prospective Study

Background: Laparoscopic cholecystectomy considered as the gold standard treatment for symptomatic gall stone disease has 1-13% conversion rate to an open procedure due to various reasons. Present study aims to predict difficult laparoscopic cholecystectomy preoperatively using clinical and sonological factors.Methods: This is a prospective study done on 190 patients who were posted for laparoscopic cholecystectomy from March 2015 to February 2017. Parameters taken into consideration were: age, number of previous attacks of acute cholecystitis, impacted gallstone, thickness of GB wall, pericholecystic fluid collection, history of upper abdominal surgery and obesity. All surgeries were performed by surgeons with minimum ten years of experience on laparoscopic cholecystectomy and ultrasound of the abdomen was performed by senior radiologists with experience of minimum five years.Results: Out of 190 patients, difficulty was experienced in 48 patients of which conversion to open cholecystectomy was needed for 11 patients. Elderly age, multiple attacks of pain abdomen (>2), palpable GB, impacted gallstone, thickness of GB wall >3 mm, peri-GB fluid collection, adhesions due to previous abdominal surgery and obesity were all found to be independent risk factors leading to difficult laparoscopic cholecystectomy.Conclusions: Though there is no definite scoring system to predict difficult LC, there is scope for further refinement to make the same less cumbersome and easier to handle using the above clinical and radiological factors.

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Subhepatic caecum and appendix - a rare variant in an adult male cadaver

National Journal of Clinical Anatomy ◽

10.1055/s-0039-3401707 ◽

2013 ◽

Vol 02 (02) ◽

pp. 093-096

Author(s):

P. Savithri

Keyword(s):

Iliac Fossa ◽

Abdominal Cavity ◽

Intestinal Loop ◽

Diagnostic Challenge ◽

Inferior Surface ◽

Male Cadaver ◽

Hypochondriac Region ◽

Right Lobe ◽

The Right ◽

Symptoms And Signs

AbstractIn unusual cases of malrotation or incomplete rotation of caecum , the appendix is not located in the lower right quadrant. When the caecum is high [subhepatic caecum] the appendix is located in the right hypochondriac region and the pain in these cases is located there, not in the lower right quadrant. In this position , the symptoms and signs of acute appendicitis may mimic acute cholecystitis, diagnosis in such cases is a great diagnostic challenge. The author observed this less frequent anomaly in a middle aged male cadaver. After opening the abdomen while tracing peritoneal reflections abnormality was identified. The caecum and appendix were present in relation with inferior surface of liver. Embryologically, the caecal swelling appears as a small conical dilation of the caudal limb of primitive intestinal loop and it is the last part of the gut to reenter the abdominal cavity. It is temporarily located in the right upper quadrant directly below the right lobe of liver. From here it descends into the right iliac fossa. The failure to descend leads to subhepatic caecum.

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Diagnosis of Helicobacter pylori in cholelithiasis and cholecystitis: by histology and serological association

International Surgery Journal ◽

10.18203/2349-2902.isj20195110 ◽

2019 ◽

Vol 6 (11) ◽

pp. 3986

Author(s):

Srinivasan Doraiswamy ◽

Dharmendra Kumar ◽

P. N. Sreeramulu ◽

Suresh .

Keyword(s):

Helicobacter Pylori ◽

Open Cholecystectomy ◽

Gall Stone ◽

Stone Disease ◽

Marked Rise ◽

Female Ratio ◽

Gall Stone Disease ◽

Calculus Disease ◽

Set Up ◽

Calculous Cholecystitis

Background: Biliary calculus disease is one of the most common disorders affecting the gastrointestinal tract. It is an important cause of morbidity. There has been marked rise in the incidence of gall stone disease in the west. In India, it is more common in northern states than in South India. Incidence of gallstones increases with age with a male to female ratio of 1:4. About 50% of these patients are asymptomatic.Methods: An analytical prospective study on patients diagnosed with cholecystitis and/or cholelithiasis was conducted in R. L. Jalappa Hospital Tamaka, Kolar. 58 patients were included in the study between June 2018 and May 2019. Data was collected and analysed using SPSS 22 version software. Categorical data was represented in the form of frequencies and proportions.Results: The age incidence was found to be highest between 31 to 40 years. The incidence of cholelithiasis was more in females. All patients presented with pain abdomen. Calculous cholecystitis was the most common mode of presentation. Open cholecystectomy was commonly done for cholelithiasis in our set up. Chronic calculous cholecystitis is the commonest histopathology.Conclusions: According to our findings evidence of recent and chronic infection Helicobacter pylori as shown by demonstration of IgM and IgG class of antibodies respectively to the organism was found in most of patients and histological evidence of the patients with cholecystitis and cholelithiasis. Thus, the frequency of helicobacter infection seems to be low in the patient population studied.

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Evaluation of patients undergoing cholecystectomy with special reference to post-cholecystectomy syndrome

International Surgery Journal ◽

10.18203/2349-2902.isj20182245 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2313

Author(s):

P. S. Khatana ◽

Jitendra Kumar ◽

Deepak Kumar Sharma

Keyword(s):

Open Cholecystectomy ◽

Gall Stone ◽

Stone Disease ◽

New Delhi ◽

Biliary Disease ◽

Medical College ◽

Number Of Patients ◽

Gall Stone Disease ◽

The Mean ◽

Age Range

Background: Significant percentage of patients remain symptomatic even after the cholecystectomy surgery for gall stone disease. Traditionally, this has been termed Post-Cholecystectomy syndrome which may consist of same symptoms for which cholecystectomy was performed or it may be a new set of symptoms that have developed after cholecystectomy. Aim of this study to find out incidence as well as pre-operative, intra-operative and post-operative determinants for the post- cholecystectomy syndrome.Methods: This is the prospective study, done in the Department of Surgery, Dr BSA Medical College and Hospital, New Delhi. Total 102 number of patients were included in this study, out of which 51 patients underwent open and another 51 patients underwent laparoscopic cholecystectomy.Results: The mean age of the patients was 40.29±10.69 years with an age range of 19 to 80 years. Incidence rate of post cholecystectomy symptoms were16.66% (n=17). Incidence of post-cholecystectomy syndrome in patients who underwent laparoscopic cholecystectomy were 15.69% (n=8) while in the open cholecystectomy group it was 17.64% (n=9). Out of seventeen symptomatic patients, eight (47.05%) were having the biliary disease while nine patients (52.95%) were having non-biliary cause.Conclusions: As authors studied present symptomatic group of patients thoroughly, it has become clear that the post-cholecystectomy symptoms are multiple and diverse arising from various causes; which in reality has no relation with the removal of gall bladder. Hence the appellation ‘post-cholecystectomy syndrome is inappropriate and instead we have used the term ‘Post-Cholecystectomy Symptoms’ for these patients.

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Prediction of difficulties during laparoscopic cholecystectomy by preoperative clinical examination and ultrasonography

International Surgery Journal ◽

10.18203/2349-2902.isj20171137 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1335 ◽

Cited By ~ 1

Author(s):

Arun Kumar ◽

Kunwar Vishal Singh ◽

Jugendra Pal Singh Shakya ◽

Sangita Sahu ◽

Soniya Dhiman ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Clinical Examination ◽

Conversion Rate ◽

Open Cholecystectomy ◽

Gall Stone ◽

Stone Disease ◽

Medical College ◽

Preoperative Ultrasonography ◽

Gall Stone Disease ◽

Symptomatic Gall Stone

Background: Cholelithiasis (gall stone disease) is a well-known disease worldwide. Ultrasonography is the most common screening test for cholecystitis and cholelithiasis. Laparoscopic Cholecystectomy is considered the treatment of choice for symptomatic gall stone disease. It is important to know the different clinical, radiological parameter and specific predictor that give some prediction of difficult LC. The aim of this study was to predict the difficulty of LC and the possibility of conversion to OC before surgery using the clinical and ultrasonographic criteria in our set up.Methods: The present study was carried out in the Department of surgery, Sarojini Naidu Medical College Agra, from November 2014 to October 2016. A total of 210 patients were enrolled for the laparoscopic cholecystectomy. All patients who were included in the study were undergone detailed history and clinical examination. A number of clinical and ultrasonographical parameters were noted.Results: Amongst the 210 patients admitted for laparoscopic cholecystectomy, 21 (10%) were male and 189 (90%) female, with age ranging from 12–60 years. The conversion rate in our study was 4.5% (9 of 210). In our study significant pre-operative factors which increased the conversion rate to open cholecystectomy includes male gender, obesity, abdominal scar of previous surgery, contracted and thickened gall bladder and patients having stone impacted at the neck of gall bladder.Conclusions: From this study, we conclude that preoperative ultrasonography is a good predictor of difficult laparoscopic cholecystectomy in the majority of cases and should be used as a screening procedure.

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Non-Tender Huge Abdominal Mass in an Adolescent

Sultan Qaboos University Medical Journal [SQUMJ] ◽

10.18295/squmj.2021.21.02.022 ◽

2021 ◽

Vol 21 (2) ◽

pp. e308-311

Author(s):

Shashi Kiran ◽

Shiekha S Jabri ◽

Yasser A Razek ◽

Meka N Devi

Keyword(s):

Minimally Invasive ◽

Abdominal Mass ◽

Abdominal Cavity ◽

Diagnostic Challenge ◽

Current Case ◽

Giant Cyst ◽

Minimally Invasive Surgical ◽

Contrast Enhanced ◽

Paraovarian Cyst ◽

The Right

Paraovarian cysts constitute about 10% of all adnexal masses in females and occur most commonly in the third and fourth decades of life. These cysts are benign and usually uncommon in adolescence. Such cysts pose a diagnostic challenge while distinguishing them from ovarian cysts clinically and during radiological investigations. We report a rare case of a 13-year-old female patient with bilateral paraovarian cysts, including a giant cyst in right mesosalpinx presenting to Sohar hospital, Oman in 2018. The definitive origin of the huge mass on the right side of abdominal cavity could not be established in the current case despite contrast enhanced computerized tomography. It was only on laparoscopic exploration that this mass was identified as a giant paraovarian cyst. Both the giant cyst and a smaller paraovarian cyst on the left side were enucleated with minimally invasive surgery while preserving the fertility of the patient. Only one other similar case of bilateral paraovarian cysts in an adolescent, including a giant cyst managed with laparoscopy, has been documented previously. Keywords: Adolescent; Parovarian Cyst; Laparoscopy; Ultrasonography; Minimally Invasive Surgical Procedures; Case Report; Oman.

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Laparoscopic cholecystectomy for gall stone disease. A single center experience.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.09.5969 ◽

2020 ◽

Vol 27 (09) ◽

pp. 1983-1988

Author(s):

Shehzad Ahmad Qamar ◽

Munawar Jamil ◽

Kokab Salim

Keyword(s):

Laparoscopic Cholecystectomy ◽

Open Cholecystectomy ◽

Demographic Data ◽

Gall Stone ◽

Major Complication ◽

Stone Disease ◽

Safe Procedure ◽

Trocar Site ◽

Single Center Experience ◽

Gall Stone Disease

Objectives: Laparoscopic cholecystectomy has turned into the gold standard for patients with symptomatic cholelithiasis. But still this procedure is not complication free. Many a time’s laparoscopic cholecystectomy needs to be converted to open cholecystectomy. Study Design: Observational study. Setting: Civil Hospital Bahawalpur. Period: 3 years from July 2015 to June 2018. Material & Methods: Carried out to review the frequency of complications encountered in laparoscopic cholecystectomy by assessing 400 cases of laparoscopic cholecystectomies. Performa was intended to incorporate important demographic data, history of illness, examination and investigations. Results: The major complication of our procedure was bleeding. Bleeding from the trocar site happened in 11 cases (2.75%), vascular damage in the callots triangle in 2 (0.5%) and from liver bed in 19 (4.75%) cases, followed by biliary leak that happened in 20 (5%) cases. Spilled gallstones were seen in 8(2%), Port site infection in 24 (6%) cases. Common bile channel stricture was accounted for in 5 patients, 14 (3.5%) out of 400 patients were converted to open surgery. Mortality was low for our situation I.e. 1 patient. Conclusion: Laparoscopic cholecystectomy is becoming a safe procedure in terms of complications.

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Incidental Carcinoma Gall Bladder in Patients Undergoing Cholecystectomy for Chronic Calculus Cholecystit is

TAJ Journal of Teachers Association ◽

10.3329/taj.v22i2.37728 ◽

2009 ◽

Vol 22 (2) ◽

pp. 223-226

Author(s):

PK Biswas ◽

PK Das ◽

MH Rahman ◽

DK Mahanta

Keyword(s):

Gall Bladder ◽

Imaging Techniques ◽

Strong Association ◽

Gall Stone ◽

Stone Disease ◽

Chronic Cholecystitis ◽

College Hospital ◽

Medical College ◽

Carcinoma Gall Bladder ◽

The Right

Carcinoma gall bladder (CaGb) is the most common neoplasm of biliary tract. Aetiology of this tumour is complex, but there is a strong association with gall stones. The symptoms are seldom suggestive of cancer and imaging techniques are usually equivocal. This study was conducted to see the frequency of cancer of gall bladder in patients undergoing surgery for chronic cholecystitis with cholelithiasis in different age and sex groups in our population. An observational study was conducted in the department of surgery unit-II Rajshahi Medical College Hospital and Mukti Clinic Rajshahi on the patients admitted with the diagnosis of chronic cholecystitis with cholelithiasis for surgery. Demographic, clinical presentation, imaging studies, operative intervention and histopathological results were examined. Over the period of 18 months 184 patients were admitted with the diagnosis of chronic calculus cholecystitis for cholecystectomy. 2 (1.09%) patients out of 184 admitted cases were diagnosed as carcinoma gall bladder after histopathology examination. Mean age was 38.5 (41h decade) years and both of them were female. The most common presenting complaints were pain in the right hypocondrium and dyspepsia (51.07%). Normal wall thickness with stone was the most common (63.04%) Ultrasonographic finding. Histologically all CaGb cases were adenocarcinoma. Gall bladder malignancy occurs commonly in 4th decade of life. The patients should be encouraged to have gall bladder surger y once diagnosed as gall stone disease. Every gall bladder specimen should be sent for histopathological examination.TAJ 2009; 22(1): 223-226

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