A rare complication of cholecystolithiasis: perforation of the gallbladder

Common complications of cholelithiasis include gallbladder inflammation, cholangitis, and acute pancreatitis. On the other hand, rare complications include gallbladder carcinoma, gallstone ileus, Mirizzi syndrome and gallbladder perforation. Some patients with cholecystitis do not require hospitalization. It is of key importance for proper further diagnosis and treatment to remember about the possible complications of cholecystitis, especially in oligosymptomatic patients. Therefore, ultrasound examinations in patients with a history of gallbladder stones should be performed with appropriate care. Ultrasound should be performed carefully in patients with a history of cholecystolithiasis, especially those oligosymptomatic, bearing in mind that there are some rare complications of this highly common clinical entity.

Causes and Treatment of Acute Cholecystitis in Khost Teaching Hospital in age group of 30-80Y during one year of 2019

Background: The presence of gall stones in the biliary system, especially in the gallbladder, can cause serious problems. Objective: The aim of the present study was to study the pattern and frequency of acute inflammation of the gall bladder on patientsaged 30 to 80 years in Khost Teaching Hospital in the year 2019.Material and Methods: In this retrospective research, the patients who were suffering from gall bladder inflammation, and all 51 patients who have been referred to the surgical department of Khost Teaching Hospital for gallbladder inflammation in the last year 2019, and their ages are 30 to 80 years old, were involved after taking prior government approvals. Results and Discussion: According to pathology, in this study from a total of 51 patients, 90% of causes were stones for acute inflammation of gall bladder (GB), hydrops type of GB was 4%, and inflammatory calculus cases were 6%. Compared to other surgical cases, GB-inflammation corresponds to 4%. The occurrence of the disease is in the age of 41 to 50 years and is most common in the female gender.We have done for all cases, open surgery, and in four cases, included cholecystectomy common bile duct (CBD) exploration was also done. Complications were rare and occurred as bile leakage and bleeding. That mortality is less. 48 (94%) causes of inflammation were stones and hydrops type, and 3 (6%) causes were without stones. Conclusion: This research shows that gallbladder inflammation is more common in urban areas, and the inflammation of the gallbladder is more common in the presence of stones than in non-stones.

An Unexpected Case of Perforated Acalculous Cholecystitis Caused by a Fish Bone

Gallbladder inflammation is most often determined by the presence of gallstones. Acalculous cholecystitisusually occurs in patients with multiple comorbidities or with an immunosuppressed status, and therefore itsevolution is faster and more severe compared to acute calculous cholecystitis. The presence of a fish bone intothe peritoneal cavity, through a gastrointestinal fistula is not very rare, but acute cholecystitis caused by a fishbone is unexpected. Here, we present the case of a 75-year old woman who had eaten fish two months beforeand presented at the Emergency Room with perforated acalculous cholecystitis and a right subphrenic abscess.The laparoscopic approach permitted the evacuation of the subphrenic abscess, bipolar cholecystectomy andremoval of a fish bone from nearby the cystic duct. Postoperative evolution was uneventful, with hospitaldischarge after five days. The patient was in good clinical condition at two months follow-up.

Comparative analysis of surgery for acute cholecystitis: before and after national recommendations acceptance

Aim. To determine the ways to reduce postoperative morbidity and mortality in acute cholecystitis. Material and metods. Retrospective (2013–2014 years) and prospective non-randomized (2015–2016) analysis of outcomes in 804 patients with acute cholecystitis was performed. Analysis was carried out within two periods – before and after acceptance of national clinical recommendations “Acute cholecystitis” (2015). Protocols of diagnosis and treatment developed by our clinic were applied in the first period (2013–2014). 220 patients (group I) underwent surgery in the first period, 290 (group II) – in the second period. Results. There was significantly reduced incidence of conversions for laparoscopic and minimally invasive cholecystectomy from 4.09% to 2.41% (p < 0.05) (OR – 1.724; 95% CI 0.632–4.705). Incidence of extrahepatic bile ducts lesion, postoperative thrombotic, thromboembolic complications, cardiovascular complications (including myocardial infarction) were similar in both groups (p > 0.05) (for cardiovascular complications OR – 0.758, 95% CI 0.047–12.183). There was reduced length of hospital-stay from 11.5 ± 0.8 to 9 ± 0.5 days (p < 0.05). Slight augmentation of postoperative mortality in the second period (from 0.45% to 1.37%) was observed (p < 0.05) (OR – 3.063, 95% CI 0.340–27.599). Conclusion. Reduced number of conversions was predominantly caused by cholecystectomy in patients with milder gallbladder inflammation. It is explained by earlier surgery (within 24–48 h) when severe infiltration of surrounding tissues is absent. Preoperative prolonged medication (3–5 days) aggravates these processes, creates significant intraoperative technical difficulties and increases incidence of conversions.

Consequences of gallbladder inflammation: spontaneous cholecystocutaneous fistula: a case report

One of the most unusual complications in gall bladder disease is spontaneous cholecystocutaneous fistula (SCF), which has only been reported a few times in the literature. We report the case of a 67-year-old man who presented with a right hypochondrium discharging sinus. Identification of a cholecystocutaneous fistula was made by computed tomography with contrast media, followed by MRCP. This confirmed the presence of a fistulous pathway between the gallbladder and the skin. The patient underwent exploratory laparotomy with subtotal cholecystectomy with en block aponeurotic muscle, skin and fistula orifice excision.