Gangrenous cholecystitis

A woman in her nineties presented with a 7-day history of right upper quadrant pain, nausea and anorexia. Examination findings included tenderness in the right upper quadrant and a positive Murphy's sign. Laboratory studies were unremarkable with normal white cell count, C-reactive protein and liver functions tests. Ultrasound of the abdomen, however, demonstrated a distended gallbladder containing sludge and a thickened gallbladder wall. The patient's symptoms worsened with associated elevation of inflammatory markers despite initial treatment with intravenous antibiotics for 24 h...

Emphysematous cholecystitis is a potentially life-threatening variant of acute cholecystitis, characterized by the presence of gas in the gallbladder wall/lumen due to the proliferation of gas-producing bacteria. Symptoms include upper right quadrant pain, fever, nausea, and vomiting. Laboratory tests may show nonspecific indications of systemic infection, and radiological assessment, especially CT scanning, is crucial for diagnosis. This case underscores the significance of early diagnosis and intervention in managing emphysematous cholecystitis to prevent serious complications and reduce the higher mortality rate compared to acute cholecystitis...

Video 1Treatment of Bouveret syndrome with stone fragmentation using an endoscopic submucosal dissection knife. A 61-year-old man with a 3-decade history of recurrent cholecystitis presented to the community emergency department with severe right upper quadrant pain. A CT scan was performed and revealed gangrenous cholecystitis with likely cholecystoduodenal fistulous communication.After discussion with the patient and the HPB team, the plan was made to attempt endoscopic extraction of the obstructing stone...

The effect of robotic-assisted cholecystectomy (RAC), when performed after hours, on perioperative outcomes has not been evaluated against outcomes achieved during normal business hours. Subjects 18-80 years old who underwent da Vinci robotic-assisted cholecystectomy from August 2018 to February 2021 were included. Baseline and 30-day perioperative outcomes were retrospectively and consecutively collected and analyzed. Inverse probability treatment weighting (IPTW) was performed to balance patient characteristics between groups...

Over the past half century, diseases that were predominantly treated surgically have transitioned to less invasive medical therapies. Such diseases that are now effectively treated with medicine are (1) peptic ulcer disease (PUD), (2) coronary artery disease (CAD), and (3) gastrointestinal stromal tumors (GISTs). Likewise, gallstone disease may soon follow this trend. Currently, the gold standard treatment of symptomatic gallstones is laparoscopic cholecystectomies. Though one of the most common surgeries in the United States, certain cases of acute and gangrenous cholecystitis can be some of the most difficult surgeries to perform...

Gallbladder volvulus is a rare condition that disproportionately affects elderly women. It occurs in patients with aberrant anatomy that results in a hypermobile gallbladder free to twist on the mesentery, leading to ischemia and necrosis. Due to its close resemblance to cholecystitis, it is difficult to diagnose preoperatively, thus most cases are diagnosed intraoperatively. In our case, a 90-year-old female was transferred to the hospital from an outside facility after being diagnosed with acute cholecystitis...

This case report describes a laparoscopic approach using fluorescence imaging guidance to treat gangrenous cholecystitis with perforation (GCP). A male patient in his early 60s presented with 3 days of right upper abdominal pain. Computed tomography and ultrasonography findings were consistent with a stone incarcerated in the gallbladder neck, GCP, and localized peritonitis. Percutaneous gallbladder drainage was initially performed, followed by laparoscopic cholecystectomy 7 days later, using combined intravenous and intracholecystic fluorescent cholangiography...

BACKGROUND: Gastro-entero-pancreatic neuroendocrine tumors are gradually seeing their incidence increase, probably due to their low-rate mortality. Surgery and subsequent medical therapy through octeotride and somatostatin analogues is the recommended approach for hypersecretive hormonal forms, showing an effective control of symptoms and improved survival outcomes. AIM: The present study aims to evaluate the occurrence of gallbladder lithiasis, and its complications, in patients underwent upfront surgery for neuroendocrine tumors and subsequent long-term administration of somatostatin analogues...

Gangrenous cholecystitis (GC) is a severe form of acute cholecystitis (AC) with ischemia and necrosis of the gallbladder (GB) wall. Patients with GC are sicker than the usual AC patients, and their surgical treatment is more complex and linked with a higher risk of morbidity and mortality. Typically, the first imaging modality used to assess patients with clinically suspected AC is ultrasound. However, if the ultrasound results were inconclusive, a CT scan might help evaluate these individuals. Our study presents a 62-year-old male who presented with mild right upper quadrant discomfort...

BACKGROUND: This study aims to assess the effectiveness of neutrophil/lymphocyte ratio (NLR) and C-reactive protein (CRP) in diagnosing cholecystolithiasis with cholecystitis in elderly patients. Additionally, the study seeks to determine the predictive value of preoperative NLR in determining the severity of the condition in this population. METHODS: This study is a retrospective cohort study, including 160 elderly patients with cholecystolithiasis with cholecystitis (45 cases of simple cholecystitis, 58 cases of suppurative cholecystitis, 57 cases of gangrenous cholecystitis) and 60 cases of normal gallbladder histology...

The prediction of severity in acute calculous cholecystitis (AC) is important in therapeutic management to ensure an early recovery and prevent adverse postoperative events. We analyzed the value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammatory index (SII) to predict advanced inflammation, the risk for conversion, and postoperative complications in AC. Advanced AC was considered the cases with empyema, gangrene, perforation of the gallbladder, abscesses, or difficulties in achieving the critical view of safety...

Gallbladder perforation is an uncommon occurrence that demands prompt surgical intervention, typically observed in the context of acute cholecystitis. In this article, we present an extraordinary case of gallbladder gangrene and perforation, originating from metastasis of colon cancer. The patient's presentation included an incidental discovery of colon cancer, which was indicated by histopathology of the gall bladder. This case report aims to shed light on the intricate relationship between gallbladder pathology and metastatic colon cancer, emphasizing the need for vigilant evaluation and comprehensive management strategies...

Ectopic pancreatic tissue is a rare congenital abnormality defined as the abnormal location of pancreatic tissue outside the anatomical site of the pancreas without any anatomical or vascular connection to it, which is often discovered incidentally. This is a case of a 40-year-old man who was admitted to our surgical department for emergency cholecystectomy due to acute gangrenous cholecystitis. Preoperative ultrasound imaging was indicative only of multiple stones in the gallbladder. Postoperative histopathological examination revealed an area of wall thickening in the neck region of the gallbladder consists of ectopic pancreatic tissue...

Mucinous ovarian cancer occurs sporadically, with a frequency of approximately 3-5% among all subtypes of ovarian cancer. Extreme leukocytosis >40,000 and 50,000 has been described in most solid tumors and is associated with a poor prognosis, although there is a lack of literal data of its occurrence after cytoreductive surgery and HIPEC in the treatment of advanced mucinous ovarian cancer. There is higher risk of the occurrence of cholecystitis in oncology patients compared to the general population, although there is no formal evidence for this, and the association with ovarian cancer is accompanied by a relative risk of 1...

Acute cholecystitis (AC) is an acute inflammatory process of the gallbladder that may be associated with potentially severe complications, such as empyema, gangrene, perforation of the gallbladder, and sepsis. The gold standard treatment for AC is laparoscopic cholecystectomy. However, for a small group of AC patients, the risk of laparoscopic cholecystectomy can be very high, mainly in the elderly with associated severe diseases. In these critically ill patients, percutaneous cholecystostomy or endoscopic ultrasound gallbladder drainage may be a temporary therapeutic option, a bridge to cholecystectomy...

BACKGROUND: The utility of the SAND balloon catheter in laparoscopic cholecystectomy for acute cholecystitis (AC) remains unclear. METHODS: A retrospective cohort study of patients who underwent emergency cholecystectomy at Shinshu University was performed to evaluate the efficacy of the SAND balloon catheter in cases of AC (SAND balloon utilization: Group S, n = 44; non-utilization: Group non-S, n = 47). RESULTS: The duration of surgery was significantly shorter in Group S than in Group non-S (p = ...

Inflammation of the gallbladder, also known as acute cholecystitis, may be caused by infection and inflammation of the gallbladder wall due to bile stasis, with or without gallstones. It is one of the most common surgical procedures that are performed laparoscopically. Gangrenous gallbladders are one of the most difficult conditions to treat clinically and surgically, being the cause of many medical malpractice litigations. Gangrenous gallbladders constitute 15% of all laparoscopic surgeries, with the cost of these surgeries being approximately $48,000, compared to other laparoscopic gallbladder surgeries being around $7,000...

Acute cholecystitis is the most common presentation of gallbladder (GB) disease. It has an incidence of around 200,000 cases a year in the United States (US) and affects approximately 20 million individuals in the US. In most cases, it presents with a history of symptomatic gallstones. Initial management includes intravenous hydration and antibiotics, bowel rest, and analgesia. Complicated cases are typically resolved with surgery (laparoscopic cholecystectomy). The pathogenesis of acute cholecystitis is most often explained by obstruction of the cystic duct...

BACKGROUND: Percutaneous cholecystostomy (PC) can be used as bridging or definitive therapy in some cases of acute cholecystitis. We aimed to compare hospital stay and survival of patients that underwent PC insertion because of acute calculus cholecystitis (ACC) compared to those who did not. METHODS: This is a retrospective study in which patients with gangrenous cholecystitis and perforation were excluded. Regression models were used to evaluate the influence of PC on mortality and hospital stay...

OBJECTIVES: Studies have shown the feasibility of short-course antimicrobials in complicated intra-abdominal infection (CIAI) following source control procedure (SCP). This study aimed to compare postoperative complication rates in short-course (5 days) and conventional (7-10 days) duration groups after antimicrobial therapy. METHODS: This was a single-centre, open-labelled, randomised controlled trial conducted in Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India, from July 2017 to December 2019 on patients with CIAI...