Luschka Ducts of the Gallbladder in Adults: Case Series Report and Review of the Medical Literature

Luschka ducts (LD) of the gallbladder (GB) are rare congenital lesions. They are defined as bile ducts that connect directly the hepatic bile duct system to the GB. We aimed to present the characteristics of 55 cases of GB LDs as diagnosed on cholecystectomy specimens. Surgically resected GBs (55) were analyzed for LD morphological features (length, morphological pattern, and epithelial lesions) as well as for immunohistochemical features. The age varied between 24 and 88 years. The gender ratio was 30:25 (female–male). The diagnosis was acute and subacute/chronic cholecystitis (21 and 34 cases, respectively). GB abnormalities of Rokitansky-Aschoff sinus, adenomyoma, septate, and subserosal-liver types were present in 36, 6, 22, and 12 GBs, respectively, while adenocarcinoma was present in 2 GBs. A history of renal cyst, pancreatitis, and colon diverticulosis was observed in 8, 11, and 4 cases, respectively. The LDs were detected at subserosal, resection, or both sites (25, 4, and 26 cases, respectively). The length varied between <1 and 36 mm. Duct-type LDs were observed in 17 cases, complex-type LDs in 5 cases, and mixed-type LDs in 33 cases. Mucosecretion was seen in 12 LDs and cystic dilatation in 8 cases. Epithelial atypia was observed in 2 cases and meganucleoli in 15 cases. Presence of LD-angulation correlated with chronic cholecystitis, while LD-nuclear atypia correlated with acute cholecystitis. In conclusion, LDs may harbor varied aspects, from duct-like or cystic, to nodular, biliary adenoma-like complexes. GB abnormalities of Rokitansky-Aschoff sinus, septa, or subserosal-liver types and extra-GB lesions such as renal cysts, pancreatitis, and colon diverticulosis were associated.

FEATURES OF COLON DIVERTICULOSIS LATE COMPLICATIONS SURGICAL TREATMENT

Diverticular disease of the colon is frequent bowel disease. Wide spread of this pathol- ogy, especially among elderly patients, is caused by characteristics of the diet in developed countries. In modern conditions the clinician is faced with the complicated forms of diverticular disease, in some cases requiring urgent surgical intervention. However, the frequency of diagnostic errors on the back- ground of complicated diverticular disease can reach significant values. A clinical case, indicating the significant difficulties, appearing while diagnosis and surgical treatment of diverticular disease late complications is exampled.

Diverticulitis

Diverticular disease includes two conditions: diverticulosis and diverticulitis. Both involve saclike protrusions of the mucosal and submucosal walls, typically in the colon. Diverticulosis is the presence of multiple diverticula, which may or may not be symptomatic. Symptomatic diverticulosis presents with indistinct symptoms and, less commonly, with severe symptoms, such as slow bleeding (causing anemia) or rapid bleeding (causing frank hematochezia and even hemodynamic instability). Diverticulitis is acute or chronic inflammation of the diverticula, possibly leading to abscesses and even perforation. Classic diverticulitis includes fever, leukocytosis, and left-sided abdominal pain, with localized tenderness and guarding. Incidence of disease increases with age. CT is the gold standard for diagnosis, which rules out other abdominal pathology and detects any diverticular complications. An outpatient course of oral antibiotics is prescribed for uncomplicated diverticulitis in an immunocompetent patient. Indications for surgery are generalized peritonitis or large abscesses that cannot be drained.