Intraoperative scoring system for grading severity of cholecystitis at laparoscopic cholecystectomy

Background: Various studies had been carried out to evaluate the risk of preoperative conversion in laparoscopic cholecystectomy. However, there was no grading or scoring of operative findings during surgery at present, making it difficult to compare the publications citing outcomes, including the conversion to open surgery. Sugrue in 2015 devised a scoring system based upon the intraoperative findings in Laparoscopic cholecystectomy. Aim of the study was to grade the severity of cholecystitis during laparoscopic cholecystectomy using intraoperative scoring system, to evaluate the spectrum of cholecystitis in cases of laparoscopic cholecystectomy in a tertiary center using the grades of intraoperative scores and to validate the scoring system devised by Michael Sugrue.Methods: This prospective cross sectional observatory study of 200 patients admitted for laparoscopic cholecystectomy was conducted in the Department of Surgery, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India over a period of 12 months. All patients directly planned for open cholecystectomy and carcinoma gall bladder were excluded from the study. Patients were subjected to the intra operative grading system for cholecystitis severity as devised by Micheal Sugrue and the grades were classified with a score of <2 - mild; 2 to 4 -moderate, 5– 7- severe and 8 to 10 – extreme.Results: The operative grading system showed a positive correlation with the severity of cholecystitis.Conclusions: Use of this intra-operative scoring system will help us to provide a trigger for a prompt early conversion to avoid intra-operative complications associated with difficult laparoscopic cholecystectomy.

MDCT Angiography Evaluation of Arterial Involvement in Carcinoma Gall Bladder: An Institutional Experience

Purpose: Evaluation of pattern of arterial involvement in advance case of gallbladder carcinoma with MDCT Angiography. Method: All CT examinations were performed on a 64- MDCT scanner (Philips Medical System Version 6.4, Extended Brilliance Workspace). Technical features of MSCT were as following 64mm � 1mm collimation, minimum slice thickness of 0.625, gantry rotation time of 320ms, kV of 120, and mAs of 320. CT Angiography was performed with IV administration of nonionic contrast material i.e. omnipaque. The contrast medium and saline solution were injected with a medrad power injector at 4mL/sec through an 18-gauge plastic intravenous catheter placed in an antecubital vein in most of the cases. Contrast medium volumes varied between 100 and 150 mL at 1.5ml/Kg. Images were obtained in triphasic pattern at arterial (20-30 seconds), portal (60-70 seconds), and equilibrium (at 3 minutes) phases. Results: Nearly half of the cases (43.5%) of carcinoma gall bladder showed arterial involvement at the time of diagnosis; most commonly involved artery was found to be cholecystic artery (24.7%) followed by right hepatic artery (14.1%) and replaced right hepatic artery (3.5%). Conclusion: We conclude that nearly half of the patients with carcinoma gall bladder have arterial involvement at the time of diagnosis. The most commonly artery involved was Cholecystic artery followed by right hepatic artery and replaced right hepatic artery. Keywords: MDCT (Multidetector computed tomography); Carcinoma gall bladder; Cholecystic artery; Hepatic artery; Right hepatic artery

Trousseau Syndrome Secondary to Carcinoma Gall Bladder: Case Report

Trousseau syndrome is the phenomenon in which an occult visceral malignancy is the underlying cause of an unexpected thrombotic event. Trousseau syndrome has a well-established association with advanced primary pancreatic and pulmonary malignancies and others like prostate, stomach, colon, and hematologic malignancies can be associated. Here we report a case from whose initial presentation we thought that it was stroke, but later she developed DVT in both legs and after investigation it was suspicious of carcinoma gall bladder. Keywords: DVT- deep vein thrombosis, VTE- venous thromboembolism, trousseau syndrome.

Mucinous Carcinoma of Gall Bladder – A Rare Case Report

Background: Mucinous carcinoma of the gall bladder is a very rare type of gall bladder carcinoma. It is characterized by production of extracellular mucin >50% of tumour volume. Case Report: We report a case of primary mucinous carcinoma of gall bladder in a 60-year-old female patient who was diagnosed clinically as acute cholecystitis. Histopathological examination gave the definitive diagnosis in this case. Conclusion: Mucinous carcinoma of gall bladder exhibit significant clinicopathological difference from conventional adenocarcinoma of gall bladder and display aggressive clinical behaviour. Key words: Mucinous Carcinoma, Gall Bladder, Primary.

Role of Tumour Markers Carbohydrate Antigen 19-9, Carcinoembryonic Antigen, & Alpha Fetoprotein in Carcinoma Gall Bladder

BACKGROUND Gallbladder cancer is recognised as an irreversible malignancy with a high fatality rate. The highest incidence of gall bladder carcinoma is seen in India and Chile, and relatively low level in many Western countries. Gall bladder carcinoma has an extremely poor prognosis, increasing incidence, and diagnosed at an advanced stage despite recent advances in diagnostic modalities. Considering the high rate of mortality attributable mainly to late detection of disease at an advanced stage, early diagnosis remains to be one of the most important determinants of the outcome. This study was conducted to assess the role of tumour markers, namely carbohydrate antigen (CA 19-9), carcinoembryonic antigen (CEA) and alpha fetoprotein (AFP) in the diagnosis of gall bladder carcinoma. We wanted to assess the diagnostic role of tumour markers in carcinoma gall bladder. METHODS Patients with radiologically and histopathologically confirmed diagnosis of carcinoma gall bladder were invited to participate in the study. A thorough history was taken, and relevant examination done as per protocol. All necessary laboratory and radiologic investigations were done according to study design. Assessment of the tumour markers CA19-9, CEA and AFP was done, and values compared with carcinoma gall bladder patients. RESULTS The diagnostic value of tumour markers has been studied in context with histopathological grade as all the cases were histopathologically proven cases of carcinoma gall bladder (Ca GB). CONCLUSIONS The present study showed that CA 19-9 was most effective with regard to its ability to differentiate between different grades of gall bladder carcinoma. KEY WORDS CA 19-9, CEA, AFP, Carcinoma Gallbladder

Frequency of gall bladder carcinoma in cholecystectomies for symptomatic cholelithiasis

It was a Letter to the Editor to find out the frequency of carcinoma gall bladder in patients which were presented with symptomatic cholelithiasis. Carcinoma of the gallbladder is a rear malignancy with 5 year survival rate of 5%. Carcinoma gall bladder is the most common billiary tract malignancy, it is also 5th most common in gastrointestinal malignancies 1. In Pakistan the incidence of carcinoma gallbladder among patients having symptomatic cholelithiasis is 6 to 28%2. Patients with symptomatic gall stones had more risk for developing carcinoma gallbladder as compared to asymptomatic gall stones. Large stones in cholelithiasis are more dangerous than small stones as stone size reaches >3cm risk increases upto 10 fold. Gallbladder polyps >10mm, calcified(porcelain) gallbladder, choledochal cyst, seclerosing cholangitis, anomalous pancreaticobillary junctions and exposure to carcinogens are other risk factors3. Continuous...