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Background: Thick wall gallbladder (TWGB) is not an uncommon finding on ultrasonography especially in region with high prevalence of gall stones disease like north India. On most occasion, these thickening could be because of benign disorders but malignancy are not a rare cause of it. Preoperative distinction between benign and malignant causes of TWGB is important as the surgical treatment entirely differ. Despite after thorough evaluation with various imaging modalities, a definitive diagnosis cannot be reached on many occasion. The aim of our study was to review the literature for the diagnosis and management approach in patients with TWGB. Methods: We perform a thorough online search of full text articles related with thick wall GB published in English literature. After doing a critical appraisal of available literature, a comprehensive narrative review was described. Conclusions: In this review, the authors have described a clinical algorithmic approach by detailing the diagnostic utility of various imaging modalities and also different surgical options for treatment especially in cases of ambiguity. [ABSTRACT FROM AUTHOR]

• Selection of patients for cholecystectomy is hampered by lack of objective criteria. • Long-term follow-up of gallstone disease patients with first admission was performed. • Baseline pain in the epigastrium, larger gallstones, and younger age determine readmission. • Half of patients ended up having cholecystectomy performed. • Identified determinants should be tested in future clinical treatment algorithms. Selection of patients for cholecystectomy is hampered by lack of objective criteria. The objectives of this cohort study were to identify if patient, symptoms, or gallstone disease characteristics determined readmission in an unselected cohort with screen-detected gallstone disease and who had experienced a first admission with symptomatic gallstone disease. Data from three random sampled population-based cohorts were used. At baseline, participants were screened with ultrasound and 664 had gallstones of which 84 had a first admission without cholecystectomy performed. A cohort study was performed with follow-up up for hospital readmissions beyond 30 days through central registers. Age adjusted Cox regression analyses were performed. Readmissions occurred in 60.8% and cholecystectomy was eventually performed in 47.7% of patients. Early readmissions were determined by abdominal pain in the epigastrium (Hazard ratio (HR) 3.63, 95% confidence interval (CI) [1.62;8.12]) and of moderate intensity (HR 2.71, 95% CI [1.20;6.16]). Late readmissions were determined by larger gallstone size, especially when above 10 mm (HR 4.11, 95% CI [1.18;14.3]) and inversely determined by age (HR 0.97, 95% CI [0.95;0.998]). In patients with initially uncomplicated gallstone disease, cholecystectomy was inversely determined by age (HR 0.96, 95% CI [0.93;0.98]). Once gallstones have become symptomatic and caused hospital admission, a persisting high risk for future readmission exists and half of patients end up having cholecystectomy. Pain in the epigastrium, larger gallstones, and younger age determine readmission. These determinants should be tested in future clinical treatment algorithms for gallstone disease. [ABSTRACT FROM AUTHOR]

The anatomic rearrangement of the gastrointestinal tract after bariatric surgery may result in alterations in the bile acid pool and consequently, gallstone disease. We aimed to investigate whether patients undergoing bariatric surgery are at risk of developing gallbladder disease postoperatively. We conducted a population-based cohort study by using claims data from the Taiwan National Health Insurance Research Database. The study cohort comprised 4197 patients diagnosed with morbid obesity. Among the morbidly obese patients, 2698 underwent bariatric surgery. Females and younger subjects were more prevalent in the surgical group than non-surgical group. Bariatric surgery reduced all obesity-related comorbidities. Cox proportional hazards regression was performed, which revealed increased risk of cholecystectomy after bariatric surgery among obese patients (adjusted hazard ratio, 3.43; p = 0.0165). After adjusting for sex and age, the incidence of cholecystectomy was increased in the females population (adjusted hazard ratio, 3.74; p < 0.05) and in 30–64 years-old-group (adjusted hazard ratio: 3.69, p < 0.05). The cumulative incidence rate of cholecystectomy showed an increased tendency in those undergoing bariatric surgery by log-rank test. Based on the Taiwan database population-based cohort study, bariatric surgery increases the risk of cholecystectomy among morbidly obese patients, especially in the female population and patients aged 30–64 years. [ABSTRACT FROM AUTHOR]

Laparoscopic cholecystectomy (LC) is widely accepted as the standard treatment for benign gall bladder diseases in humans because it has proven to be less invasive and safer than are traditional methods. However, the efficacy of LC in dogs remains unclear. The present study aimed to examine the short-term outcome of LC for benign gall bladder diseases in dogs. We enrolled 76 consecutive dogs that underwent LC for benign gall bladder diseases at our hospital between April 2008 and October 2016. Dogs with jaundice, gall bladder ruptures, abdominal effusion, or extrahepatic biliary obstruction were not excluded from the indication. Factors including age, body weight, sex, clinical sign, disease, operative time, conversion to open surgery, perioperative complications, and postoperative hospital stay were investigated. The median age of the dogs was 11 years, and the median body weight was 5.4 kg. Fifty percent of the dogs exhibited no symptoms at the initial visit. Preoperative elevation of total bilirubin levels was observed in 16 dogs (21%). LC was successfully completed in 71 dogs (93%); the median operative time was 124 min. Although gall bladder ruptures were observed in 2 (2.6%) dogs, the operations were completed successfully. Three dogs (4.1%) had to be converted to open cholecystectomy and 2 (2.6%) underwent reoperation. Two dogs (2.6%) died intraoperatively and 2 (2.6%) died postoperatively. LC was a feasible, safe, and appropriate procedure considering the current operative indications for benign gall bladder diseases in dogs. [ABSTRACT FROM AUTHOR]

Summary A 2-year-old entire female mixed-breed dog was presented with signs of cholestasis. Abdominal ultrasonography revealed a gallbladder with a thickened and hyperechoic wall and luminal calculi. Exploratory laparotomy with cholecystectomy was performed and histopathological examination of the specimens from the cholecystectomy demonstrated extensive proliferation of large, prominent nerves containing ganglion cells with no atypia mainly located in the gallbladder mucosa. The neural nature of these components was confirmed by immunohistochemical labelling with antibodies specific for synaptophysin, glial fibrillary acidic protein, S100 protein and neurofilaments. Based on these findings, the lesion was diagnosed as ganglioneuromatosis. Reports of ganglioneuromatosis in animals have so far been restricted to the intestine. This is the first case of ganglioneuromatosis affecting the gallbladder in an animal in which no intestinal involvement was apparent. Graphical abstract Ganglioneuromatosis is a rare, exuberant hyperplastic proliferation of ganglion cells and nerves of the autonomic nervous system that is restricted to the the gastrointestinal tract in animals. The present report describes the pathological and immunohistochemical features of a novel case of ganglioneuromatosis confined to the gallbladder and with no signs of intestinal involvement in a dog. Image 1 [ABSTRACT FROM AUTHOR]

Ultrasound is a frequently used diagnostic tool for gallbladder diseases. Polypoid lesions are commonly depicted at routine abdominal ultrasonography (US). The characteristics of these lesions vary. Since most early malignant tumors in the gallbladder are asymptomatic, differentiation between malignancy and benignity is crucial. Knowledge of gallbladder polypoid lesions is important so that they can be appropriately included in the differential diagnosis in patients presenting with intra-gallbladder nodules on US. This article summarizes the algorithmic approach to the diagnosis of these lesions and our recent experience with contrast-enhanced US. The clinical and imaging features of gallbladder polypoid lesions are reviewed. [ABSTRACT FROM AUTHOR]

Introduction Agenesis of gallbladder is a rare congenital anomaly of biliary tree that may be associated with other biliary and extra biliary congenital anomalies. Case presentation A 43- year- old female presented with a 4 months history of upper abdominal pain associated with nausea and vomiting. It was associated with dyspeptic symptoms and become worse following ingestion of high-fat meal contents. Clinically, a differential of gall stone disease was considered. Ultrasonography of abdomen revealed a contracted gallbladder with multiple stones with normal wall thickness, so the fact of clinical diagnosis considering finding cholithiasis. She was submitted to laparoscopic exploration which revealed that the gall bladder was absent within gall bladder fossa. Discussion In this case, the differential of cholithiasis symptoms considered support by ultrasonography, symptomatic gall stones presented more than half of cases of gall bladder agenesis, Diagnosis of gall bladder disease usually done by ultrasound modality, it must be done by expert one. Awareness of this entity by clinicians, surgeons and radiologists are essential because many of these patients present with biliary symptoms and have unnecessary operations. Conclusion Agenesis of gallbladder should be kept in mind whenever the gall bladder was improperly visualized in routine imaging methods. Ultrasonography operated dependent we must not depend on single one or even multiple done by the same person. Avoid a needless surgical exploration, which might be risky. Non-visualized gall bladder during laparoscopic cholecystectomy is challenging should not convert to open unless sure that the gall bladder was present. [ABSTRACT FROM AUTHOR]

Copyright of Konuralp Medical Journal / Konuralp Tip Dergisi is the property of Duzce University Medical School and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A 10-month-old female Japanese black heifer presenting with sudden loss of appetite was diagnosed with extreme extension of the gallbladder. Laparotomy reaching from the right part of the 10th rib to the right flank showed an extended gallbladder greater than 50 cm in diameter. Cholecystectomy was performed as follows: 1) complete removal of the gallbladder distally from the base; 2) flushing via a catheter inserted into the common bile duct; and 3) covering of the hole opened in the common bile duct with a double-suturing method using the mucous membrane and muscular layers of the remaining gallbladder structures. Serum levels of total bilirubin gradually decreased from 7.5 mg/dl preoperatively to 4.7 mg/dl, 1.6 mg/dl and 0.6 mg/dl at 3, 8 and 34 days postoperatively, respectively. The heifer showed 1 month of clinical improvements, grew normally and finally became pregnant. To the best of our knowledge, this represents the first clinical report to describe cholecystectomy in cattle. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic cholecystectomy (LC) is routinely performed as an outpatient operation. NSQIP tracks acute or symptomatic congestive heart failure (CHF) within 30 days of the index operation. This study aims to quantify adverse events after LC and determine if patients with CHF may benefit from pre-operative optimization or post-operative admission.Materials and Methods: This is a retrospective NSQIP database review of all adults undergoing LC between 2008 and 2012. Comorbidities examined were acute or decompensated CHF, along with coronary artery disease, chronic obstructive pulmonary disease, diabetes, dyspnea, obesity, and smoking status. Bivariate and multivariate analyses determined the impact of these conditions on complications.Results: LCs were performed electively in 131,081 patients and emergently in 12,680 patients. Pneumonia, reintubation or death in CHF patients occurred in 9% and 18% of these operations, respectively. The odds ratios, among those with CHF compared to those without, for pulmonary complications was 4.7 (p < 0.01, 95%CI: 3.38-6.6) in the elective and 3.7 (p < 0.01, 95%CI: 1.89-7.07) in the emergent populations.Conclusions: Patients with acute or decompensated CHF may benefit from pre-operative cardiac optimization and post-operative admission to decrease the risk of pulmonary complications. [ABSTRACT FROM AUTHOR]

Background: Laparoscopy is a surgical approach recommended for the treatment of gall bladder disease. It is recommended also in geriatric patients. Recently Single Incision Laparoscopic Cholecystectomy (SILC) has been proposed to minimize surgical trauma, recovery and hospitalization time. However, the results and advantages of SILC in the geriatric population have received minimal attention. This case series review is focused on the results of SILC in the geriatric population.Methods: The records of 355 patients who had undergone SILC were reviewed. This report identifies, in the entire cohort, 40 patients aged 65 years or older at the time of surgery who will be the object of this study (geriatric series). Clinical outcomes and results were evaluated. Moreover, post-operative pain of the geriatric cohort was compared to that of the entire series.Results: SILC was successfully completed for 347 out of 355 patients of the entire series, with no mortality reported. In total SILC was converted to standard laparoscopy in 10 patients (2.2%) but never to open procedure. No significant difference was found between the total cohort and the geriatric series in terms of median time of operation (61.20 min vs 68.38 min). Post-operative pain was significantly lower in geriatric patients.Conclusion: SILC is an effective and safe procedure for the treatment of gallbladder disease of elderly, also in terms of post-operative pain and it represents an alternative to the standard laparoscopic approach on a routine basis. [ABSTRACT FROM AUTHOR]

Purpose: Iatrogenic bile duct injury (BDI) is the most significant associated complication to laparoscopic cholecystectomy (LC). Little is known about the evolution of the pattern of BDI in the era of laparoscopy. The aim of the study is to assess the pattern of post-LC BDIs managed in a tertiary referral centre.Methods: Post-LC BDI referred over two decades were studied. Demographic data, type of BDI (classified using the Strasberg System), clinical symptoms, diagnostic investigations, timing of referral, post-referral management and morbidity were analysed. The pattern of injury, associated vascular injuries rate and their management were compared over two time periods (1992-2004,2005-2014).Results: 78 BDIs were referred. During the second time period Strasberg A injuries decreased from 14% to 0 and Strasberg E1increased from 4% to 23%, the rate of associated vascular injury was six time higher (3.6% versus 22.7%), more patients had an attempted repair at the index hospital (16% versus 35%) sand fewer patients could be managed without surgical intervention at the referral hospital (28% versus 4%).Conclusion: Complexity of referred BDIs and rate of associated vascular injuries have increased over time. These findings led to more patients managed requiring surgical intervention at the referral hospital. [ABSTRACT FROM AUTHOR]

Echogenic luminal contents are often noted during ultrasonographic examination of the gallbladder (GB) in canine patients, but the significance of biliary sludge is not well understood. GB contents were evaluated during 200 sequential ultrasonographic scans performed at a veterinary school, and sludge was quantified using a 1-5 scale. GB volume was retrospectively estimated from stored images. Medical records were used to determine patient demographics, clinicopathologic findings, and diagnoses/disorders. The majority of dogs (66.5%) had some hyperechoic material within the GB. Four dogs were diagnosed with a mucocele. For statistical purposes, dogs with uniformly nonechogenic bile or minimal sludge (80.5%) were compared to those with .25% sludge (17.5%). Dogs with .25% sludge were significantly older than those with minimal sludge (8 versus 11 yr). Serum cholesterol and bilirubin concentrations and activities of both alkaline phosphatase and gamma-glutamyl transferase were not correlated with the presence of GB sludge. Dogs with spontaneous hyperadrenocorticism or hypothyroidism were more likely to have .25% sludge (odds ratio: 5.04). In addition, .25% sludge was associated with increased GB volume, suggesting that changes in GB function or contractility may impact the formation of biliary sludge in dogs. [ABSTRACT FROM AUTHOR]

Gallstone disease is one of the most common problems in the gastroenterology and is associated with significant morbidity. It may present as stones in the gallbladder (cholecystolithiasis) or in the common bile duct (choledocholithiasis). At the end of the 1980s laparoscopy was introduced and first laparoscopic cholecystectomy was performed in 1985. The laparoscopic technique for removing the gallbladder is the current treatment of choice, although indications for open surgery exist. To perform laparoscopic cholecystectomy as safe as possible multiple safety measures were developed. The gold standard for diagnosing and removing common bile duct stones is Endoscopic Retrograde Cholangiopancreatography (ERCP). The surgical treatment option for choledocholithiasis is laparoscopic cholecystectomy with common bile duct exploration. If experience is not available, than ERCP followed by elective cholecystectomy is by far the best therapeutic modality. The present review will discuss the use, benefits and drawbacks of laparoscopy in patients with cholecystolithiasis and choledocholithiasis. [ABSTRACT FROM AUTHOR]

Background: We sought to determine the outcome predictors of 94 cirrhotic patients undergoing laparoscopic cholecystectomy (LC). Methods: We performed a single-center, retrospective review of cirrhotic patients undergoing LC for symptomatic gallbladder disease. Statistical analysis was completed using the Chi-square, Wilcoxon rank-sum, and Student t tests as appropriate. Results: Ninety-four procedures were completed. The median Child-Turcotte-Pugh (CTP) score was 6 (range, 5–12), and the average Model for End-Stage Liver Disease (MELD) score was 11 ± 5. Hepatitis C was the most common etiology of liver disease (50%) followed by Laennec''s cirrhosis (22%). The average length of stay was 2.6 ± 4.3 days; 21% were outpatient procedures. The conversion rate was 11%. Conversion risk factors were decreased serum albumin, increased MELD score, and blood loss. Morbidity occurred in 32 patients. Predictors of morbidity were decreases in serum albumin, increases in International Normalized Ratio (INR) and CTP score, and the number of intraoperative red blood cell transfusions. Mortality occurred in 4 patients. Increased INR, CTP score, CTP class, the number of intraoperative blood and platelet transfusions were predictors of mortality. Conclusion: LC can be safely performed in cirrhotic patients with appropriate patient selection. Liver synthetic function, operative blood loss, transfusion requirement, CTP, and MELD scores may be used to predict outcomes in these patients. [Copyright &y& Elsevier]

Abstract: Background: Many studies have described the risk factors of gallstone formation in gastric cancer patients after gastrectomy, but few studies focus on the management of asymptomatic gallstones. Our goal is to examine the rationale of simultaneous cholecystectomy during gastric cancer surgery, and influence of surgical mortality, morbidity and overall survival after combined cholecystectomy and gastrectomy. Methods: We retrospectively reviewed 445 gastric cancer patients and the gallbladders evaluated by abdominal ultrasound or computed tomography preoperatively and postoperatively. Clinicopathologic factors, including surgical morbidity, mortality and overall survival of combined surgery, were compared between patients receiving gastrectomy with simultaneous cholecystectomy and patients receiving gastrectomy only. We also evaluated the risk factors of gallstone formation after gastrectomy and the probability of subsequent cholecystectomy after gastrectomy in gastric cancer patients with or without asymptomatic gallstones. Results: Of 445 gastric cancer patients, 52 (11.7%) patients had asymptomatic gallstones upon diagnosis of gastric cancer. Among patients with healthy gallbladders, 15.2% developed gallstones after gastrectomy. Men and older patients (age over 60) had significantly higher risk of gallstone formation. Rate of subsequent cholecystectomy in patients with and without preoperative asymptomatic gallstones was 30.8% and 4.5%, respectively (p = 0.005). The rates of mortality and morbidity were not significantly different between combined surgery (3.4%, 24.2%) and gastrectomy only (3.1%, 22%). There was also no significant difference in 5-year survival between combined surgery (61%) and gastrectomy only (63%) groups. Conclusion: Combined cholecystectomy for asymptomatic gallstone in gastric cancer surgery may be considered. It was not associated with increased surgical morbidity or mortality, and had no significant effect on overall survival. [Copyright &y& Elsevier]

Abstract: INTRODUCTION: Ectopic hepatic tissue is due to an uncommon failure of embryological liver development that is rarely described in the world medical literature. The incidence of ectopic liver (EL) has been reported to be anywhere from 0.24% to 0.47% as diagnosed at laparotomy or laparoscopy. We describe a case of EL adherent to the gallbladder, removed at laparoscopic cholecystectomy. PRESENTATION OF CASE: A 37-year-old female was admitted for elective cholecystectomy having had an episode of acute cholecystitis provoked by gallstones. During the procedure, a 30mm×10mm×5mm section of EL tissue attached to the anterior wall of the gallbladder was identified and removed by en-bloc excision during laparoscopic cholecystectomy. Histological examination confirmed the absence of malignant degeneration of the hepatic tissue. The patient recovered well postoperatively and was discharged the day after the operation. She was well when seen six months later. DISCUSSION: EL has been reported in several sites, such as the gallbladder, gastrohepatic ligament, adrenal glands, esophagus, and thoracic cavity. EL is often clinically silent and discovered incidentally during abdominal surgical procedures or autopsies. Because patients with ectopic liver may suffer complications such as torsion, peritoneal bleeding, fatty change, and evolution to cirrhosis or malignant degeneration to hepatocellular carcinoma, any ectopic liver tissue needs to be correctly identified and removed. CONCLUSION: Despite the rare occurrence of EL, it should be recognized and removed by the surgeon to prevent a higher risk of complications and malignant transformation. [Copyright &y& Elsevier]

Summary: Background/Objectives: Our aim was to investigate the calcium content of different gallstone compositions and the pathogenic mechanisms of calcium carbonate gallstones. Methods: Between August 2001 and July 2007, gallstones from 481 patients, including 68 calcium carbonate gallstones, were analyzed for total calcium content. Gallbladder bile samples from 33 cases and six controls were analyzed for pH, carbonate anion level, free-ionized calcium concentration and saturation index for calcium carbonate. Results: Total calcium content averaged 75.6 %, 11.8 %, and 4.2 % for calcium carbonate, calcium bilirubinate and cholesterol gallstones. In 29.4 % of patients, chronic and/or intermittent cystic duct obstructions were caused by polypoid lesions in the neck region and 70.6 % were caused by stones. A total of 82 % of patients had chronic low-grade inflammation of the gallbladder wall and 18.0 % had acute inflammatory exacerbations. In the bile, we found the mean pH, mean carbonate anion, free-ionized calcium concentrations, and mean saturation index for calcium carbonate to be elevated in comparison to controls. Conclusion: From our study, we found chronic and/or intermittent cystic duct obstructions and low-grade GB wall inflammation lead to GB epithelium hydrogen secretion dysfunction. Increased calcium ion efflux into the GB lumen combined with increased carbonate anion presence increases SI_CaCO3 from 1 to 22.4. Thus, in an alkaline milieu with pH 7.8, calcium carbonate begins to aggregate and precipitate. [ABSTRACT FROM AUTHOR]

Summary: Background/Objective: Single-incision laparoscopic cholecystectomy (SILC) is emerging as an alternative to standard four-incision laparoscopic cholecystectomy (4ILC). This study presents one surgeon''s experience of SILC and a retrospective analysis of the data. Methods: Sixty-seven consecutive patients treated by a single surgeon and undergoing laparoscopic cholecystectomy (LC) for benign gallbladder diseases were enrolled. LCs were attempted with conventional instruments as follows: 24 three-incision laparoscopic cholecystectomies (3ILC); 10 two-incision laparoscopic cholecystectomies (2ILC); and 33 SILC. Results: The procedure conversion rate into the SILC, 2ILC, and 3ILC groups was 9.1%, 0%, and 8.3% respectively. Operative time was significantly longer with SILC (111.1±30.34 minutes) compared to 2ILC (79.1±15.74 minutes) and 3ILC (80.2±29.41 minutes) (p <0.01). Post-operative pethidine dosage was significantly lower in the 2ILC group (0.29±0.358mg/kg) compared to the 3ILC group (1.02±0.802mg/kg) (p <0.05). Length of hospital stay (LOS) was significantly shorter in the SILC group (2.52±0.566 days) compared to the 3ILC group (3.1±1.02 days) (p <0.05). There were no complications. Conclusions: SILC is a safe and feasible procedure that is comparable to multi-incision laparoscopic cholecystectomy (MILC). We have introduced a recommended step-by-step training program. SILC needed longer operative time than MILC but has potential benefits in terms of LOS and post-operative pain. [Copyright &y& Elsevier]

Purpose: To assess gallbladder (GB) wall thickening and periportal tracking on CT in patients with acute pyelonephritis (APN) by each kidney involvement. Materials and Methods: A total of 117 patients diagnosed with APN by clinical examination and CT were included in this retrospective study. The patients were divided into three groups based on kidney involvement seen on CT: right APN, left APN, and bilateral APN. Two radiologists reviewed CT images in consensus for the presence of diffuse GB wall thickening and periportal tracking. The prevalence of these two manifestations was compared among the three groups. Results: The prevalence of GB wall thickening in patients with right APNJ (26.4%) and bilateral APN (19%) was significantly higher than in patients with left APN (0%) (p < 0.016). The prevalence of periportal tracking in patients with right APN (15.1%) and bilateral APN (26%) was higher than in patients with left APN (3%), with a significant difference between patients with bilateral ARN and left APN (p <0.016). Conclusion: GB wall thickening and periportal tracking are predominantly encountered on CT in patients with APN involving the right kidney (right and bilateral APN), and should be considered in differential diagnosis of diseases associated with GB wall thickening and periportal tracking. [ABSTRACT FROM AUTHOR]

Abstract: Background: Endoscopic methods are currently the treatment of choice for patients with common bile duct (CBD) stones, but subsequent management of the intact gallbladder for patients following endoscopic treatment is still controversial. The primary aim of this study was to discover the association between gallbladder status and recurrent biliary complications for patients with CBD stones after endoscopic treatment. Additionally, we also sought to determine risk factors for recurrent biliary complications in these patients. Methods: The records of 1625 patients with CBD stones following endoscopic treatment were reviewed. A total of 681 patients were enrolled and subsequently categorized into four groups: Group 1 (n = 201), calculous gallbladder; Group 2 (n = 140), acalculous gallbladder; Group 3 (n = 175), elective cholecystectomy after endoscopic treatment; and Group 4 (n = 165), prior cholecystectomy. The basic demographics and recurrent biliary complications during follow-up among these four groups were analyzed by Chi-square test, ANOVA, Kaplan-Meier analysis, and log-rank test. Results: During the median follow-up period of 34 months, 133 patients (20%) with recurrent biliary complications were identified. The recurrence rates of Groups 1, 2, 3, and 4 were 29%, 11%, 15%, and 19%, respectively. Kaplan-Meier analysis showed that patients with calculous gallbladder had a significantly higher rate of recurrent biliary complication. In multivariate analysis, patients with a history of cirrhosis, juxta-papillary diverticulum, calculous gallbladder, CBD size ≥1.5 cm, and endoscopic management with endoscopic sphincterotomy were at a higher risk for developing biliary complications (p = 0.029, p = 0.039, p < 0.001, p = 0.002, p = 0.021, respectively.) Conclusion: Patients with cholecystolithiasis and CBD stones had a higher incidence of recurrent biliary complications. For some of these patients, elective cholecystectomy following endoscopic treatment may be considered. However, routine elective cholecystectomy in patients with normal gallbladder is not appropriate because of the low recurrence of biliary complications. Whether gallbladder function affects the biliary clearance and biliary complications requires further research. [Copyright &y& Elsevier]

Abstract: Knowledge on pancreaticobiliary reflux in normal pancreaticobiliary junction and their pathologic implications has experienced tremendous progress during the last few years. This article reviews the current knowledge on this condition and its pathological implications on gallbladder diseases. Many publications with different levels of evidence were found supporting biliary carcinogenesis associated with pancreaticobiliary reflux in normal and abnormal pancreaticobiliary junction. Also, there are many publications supporting the common occurrence of pancreaticobiliary reflux in normal pancreaticobiliary junction, and sphincter of Oddi dysfunction as the most plausible cause of this condition. Although an important body of research has been published regarding pancreaticobiliary reflux in normal pancreaticobiliary junction and their clinical significance, the current evidence does not fully support what has been suggested. The reflux of pancreatic enzymes into the bile tract and gallbladder is a fascinating subject of study which is open to active research. The final demonstration of the pathophysiology and consequences of PBR in NPBL and support by evidence level type I would constitute a major breakthrough in the understanding and eventually in the treatment of gallbladder diseases. [Copyright &y& Elsevier]

Abstract: INTRODUCTION: The presence of left-sided gallbladder is closely associated with multiple combined anomalies of the portal vein, hepatic vein, hepatic artery, and bile duct. This requires special attention for preoperative evaluation for the purpose of preventing postoperative complications. PRESENTATION OF CASE: A 70-year-old woman with metastatic liver cancer and intrahepatic portal vein, biliary system and hepatic artery anomalies with left-sided gallbladder is reported. On computed tomography (CT), a solitary low density mass occupied from the right anterior to the posterior segment of the liver. The gallbladder bed was on the left of the hepatic fissure. On drip-infusion-cholangiography (DIC) CT three-dimensional (3D) reconstruction, the left medial bile duct arose from the right umbilical portion after arising from the left lateral bile duct. Following a right hepatectomy and lymph node dissection of the hepatoduodenal ligament, hepaticojejunostomy was conducted separately to the left medial and left lateral bile duct. DISCUSSION: The left-sided gallbladder accompanies with several anomalies of hepatic vascular and bile duct anomalies in a frequent manner. A safe hepatectomy needs accurate operative plans to ascertain the range of hepatectomy, because it often has the diversity of a combined anomaly. CONCLUSION: Preoperative DIC-CT 3D reconstruction was extremely useful because it provided an important information that could not be obtained with 2D-DIC-CT. 3D imaging has the ability to demonstrate complex anatomical relationships, this devise is a effective new tool for making appropriate preoperative strategy. [Copyright &y& Elsevier]

Abstract: Objective: To summarize and analyze the clinical and histopathological features of chronic acalculous cholecystitis (CAC) and to investigate the diagnosis and surgical treatment of chronic acalculous cholecystit. Methods: The study subjects were 39 patients with chronic biliary symptoms but no evidence of stones in the gallbladder by B ultrasonography and magnetic resonance cholopancreatography (MRCP) (CAC group). The CCC group consisted of 66 patients taken randomly from concurrent all patients of chronic calculous cholecystitis (CCC). All patients accepted fibergastroscopy, B ultrasonography, MRCP, laboratory examination preoperatively. We retrospectively analyzed the clinical features, B ultrasonography and MRCP findings, histopathological results and clinical outcomes between the two groups. Results: All the 39 patients were diagnosed by clinical symptoms, B ultrasonography, fatty meal gallbladder contractability studies under ultrasound, fibergastroscopy and magnetic resonance cholangiopancreatography (MRCP), what''s more, they were pathologically verified postoperatively. In all patients, there was a complete absence of gallbladder wall contractability. Mucosa epithelial defect was found in 21 patients in CAC group (53.8%) and 16 patients in CCC group (24.2%) respectively (P<0.005). Thickened arteriole wall was found in 29 patients in CAC group (74.4%) and none patient in CCC group (P<0.0001). Thickened gallbladder wall (4 mm or more in thickness) was found in 33 patients in CAC group (84.6%) and 28 patients in CCC group (42.4%) respectively (P<0.005). Bile stasis was found in 23 patients in CAC group (59.0%) and 14 patients in CCC group (21.2%) respectively by ultrasonography preoperatively and confirmed in operation (P<0.005). The outcomes of cholecystectomy, expressed as total or near total relief, was similar in the two groups. No statistically significant differences were observed between patients with CAC (90%) and CCC (80%), the P-value >0.05. Conclusion: Chronic acalculous cholecystitis could be diagnosed by symptoms, ultrasound, fatty meal gallbladder contractability studies under untrasoundand MRCP. The optimal treatment of chronic acalculous cholecystitis characterized by thickened arteriole wall and mucosa epithelial defect is cholecystectomy. [Copyright &y& Elsevier]

Copyright of Radiologia Brasileira is the property of Radiologia Brasileira and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: The gallbladder specimens of patients who underwent cholecystectomy for symptomatic gallstones between 2003 and 2005 were evaluated for the presence of Intestinal Metaplasia. (IM) and its risk factors. IM was positive in 39% of 293 patients tested, and in the comparative analysis of 114 metaplasia positive versus 179 negative patients, a high risk was found in patients who were 60 years or older [adjusted odds ratio (aOR) = 3.0, 95% confidence interval (CI): 1.5, 6.2]. Other factors with aOR greater than 1 were moderate to excessive use of chilies (1.8) and ethnic origin of North India (1.7). Screening method has yet to be devised for early detection of gallbladder cancer by identifying metaplastic lesions early in life. We believe that large geographic variation and lifestyle environmental factors associated with the development of gallbladder metaplasia and cancer mortality are concealed in our study that needs to be further explored. [Copyright &y& Elsevier]

The article presents a retrospective study which assesses gallbladder sludge (GBS) prevalence in cats. It says that 152 cases of GBS are recorded between 2004 to 2008 in cats who underwent abdominal ultrasound. It states that the population of GBS-afflicted cat population is being compared to a control group of cats without GBS. The study reveals that GBS is predictive of total bilirubin (TB) and increased liver enzymes in cats and is an uncommon method for cats' ultrasonographic findings.

Abstract: Background: Laparoscopic cholecystectomy (LC) is the operation of choice in the treatment of symptomatic gallstone disease. The aim of this study is to identify risk factors for LC, outcomes include operating time, length of stay, conversion rate, morbidity and mortality. Methods: All patients undergoing LC between 1998 and 2007 in a single district general hospital. Risk factors were examined using uni- and multivariate analysis. Results: 2117 patients underwent LC, with 1706 (80.6%) patients operated on electively. Male patients were older, had more co-morbidity and more emergency surgery than females. The median post-operative hospital stay was one day, and was positively correlated with the complexity of surgery. Conversion rates were higher in male patients (OR 1.47, p = 0.047) than in females, and increased with co-morbidity. Emergency surgery (OR 1.75, p = 0.005), male gender (OR 1.68, p = 0.005), increasing co-morbidity and complexity of surgery were all positively associated with the incidence of complications (153/2117 [7.2%]), whereas only male gender was significantly associated with mortality (OR 5.71, p = 0.025). Conclusion: Adverse outcome from LC is particularly associated with male gender, but also the patient’s co-morbidity, complexity and urgency of surgery. Risk-adjusted outcome analysis is desirable to ensure an informed consent process. [Copyright &y& Elsevier]

Background: It was shown previously that LAPTM4B promoted growth of gallbladder carcinoma (GBC) cells and predicted poor prognosis in GBC; however, its roles and relative mechanisms in apoptosis of GBC cells remain unknown. Methods: The plasmids, pcDNA3-AE, containing the complete open reading frame of LAPTM4B and Mock (pcDNA3), were transfected transiently into GBC-SD cells, followed by induction of apoptosis by epirubicin. Cell apoptosis was determined by Hoechst 33258 staining, propidium iodide (PI) staining, and Annexin V/PI double staining flow cytometry. Protein expression was detected by immunoblotting. Results: Overexpression of LAPTM4B-35 was observed in cells transfected with pcDNA3-AE. These cells possessed significantly less apoptosis ratios compared with cells transfected with the Mock plasmid, although the values were still greater than those in parent cells. Of the apoptosis-related molecules, expression of Bcl-2 and Bcl-xL was up-regulated in cells transfected with pcDNA3-AE, whereas expressions of Bax, Bid, and cleaved caspase-9 and -3 were down-regulated compared with their expression in other kinds of cells. Conclusion: Our data show that LAPTM4B-35 attenuated epirubicin-induced apoptosis of GBC-SD cells in vitro through a mitochondria-dependent pathway. Therefore, the protein LAPTM4B-35 might be associated with the chemoresistance of GBC. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Jaundice is frequent in patients with gallbladder cancer (GBC) and indicates advanced disease and, according to some teams, precludes routine operative exploration. The present study was designed to re-assess the prognostic value of jaundice in patients with GBC. Methods: Patients with GBC operated from 1998 to 2008 were included in a retrospective multicenter study (AFC). The main outcome measured was the prognostic value of jaundice in patients with GBC focusing on morbidity, mortality and survival. Results: A total of 110 of 429 patients with GBC presented with jaundice, with a median age of 66 years (range: 31–88). The resectability rate was 45% (n =50) and the postoperative mortality and morbidity rates were 16% and 62%, respectively; 71% had R0 resection and 46% had lymph node involvement. Overall 1- and 3-year survivals of the 110 jaundiced patients were 41% and 15%, respectively. For the 50 resected patients, 1- and 3-year survivals were 48% and 19%, respectively (real 5-year survivors n =4) which were significantly higher than that of the 60 non-resected patients (31%, 0%, p =0.001). Among the resected jaundiced patients, T-stage, N and M status were found to have a significant impact on survival. R0 resection did not increase the overall survival in all resected patients, but R0 increased median survival in the subgroup of N0 patients (20 months versus 6 months, p =0.01). Conclusion: This series confirms that jaundice is a poor prognostic factor. However, the presence of jaundice does not preclude resection, especially in highly selected patients (N0). [Copyright &y& Elsevier]

Background & Aims: Cholecystokinin-cholescintigraphy (CCK-CS) provides a physiologic, noninvasive, and quantitative method for assessing gallbladder contraction and calculation of a gallbladder ejection fraction (GBEF). At present, it is used most commonly to identify patients with suspected functional gallbladder disorder. However, the methodology of CCK infusion and normal values differ markedly among imaging centers. Methods: This document represents the consensus opinion of an interdisciplinary panel that gathered to assess the current optimal method for performing CCK-CS in adults, potential uses and limitations of CCK-CS, and questions that require further investigation. Results: The panel recommended the use of a single, standardized, recently described CCK-CS protocol that involves infusion of 0.02 μg/kg of sincalide over 60 minutes with a normal gallbladder ejection fraction defined as ≥38%. The panel emphasized the need for a large, multicenter, prospective clinical trial to establish the utility of CCK-CS in the diagnosis of functional gallbladder disease. Although not without controversy regarding its clinical utility, the primary indication for CCK-CS at present is the well-selected patient with suspected functional gallbladder disorder. Conclusions: Agreement was reached that the adoption of this standardized protocol is critical to improve how CCK-CS is used to direct patient care and will represent an improvement over the diverse methods currently in use by eliminating the current lack of uniformity and adding both reliability and credibility to the results. [Copyright &y& Elsevier]

Abstract: Purpose: For children with upper abdominal pain and evaluation for acalculous biliary disease, laparoscopic cholecystectomy is an accepted treatment with inconsistent outcomes. The purpose of this study was to identify predictors of outcomes. Methods: One hundred sixty-seven children underwent laparoscopic cholecystectomy at a single children''s hospital. Radiographic findings, histopathology, family history, and demographics (sex, age, height, weight, body mass index–for-age percentile) were evaluated as predictors of postoperative symptomatic resolution using a binomial probability model. The data for radiologic studies and pathologic specimens were obtained via re-review in a blinded fashion. Results: Of 167 children, 43 (25.7%) had a preoperative diagnosis of biliary dyskinesia and 41 (95.3%) had documented follow-up. Mean follow-up was 8.4 months. Twenty-eight patients (68.3%) had symptom resolution. Ejection fraction less than or equal to 15%, pain upon cholecystokinin injection, and a family history of biliary disease were not predictors of symptomatic resolution. Nonoverweight patients (body mass index–for-age <85th percentile) were more likely to have symptom resolution than their overweight counterparts (odds ratio, 2.13). Most patients (68.3%) had a pathologic gallbladder on blinded review. However, this did not correlate with outcome. Conclusions: Most gallbladders removed for biliary dyskinesia are pathologic. Being overweight can be considered a relative contraindication to cholecystectomy for biliary dyskinesia. [Copyright &y& Elsevier]

Abstract: Metastatic tumors to the oral region are uncommon, and the predominant primary sites are the lung and breast. To our knowledge, only one case of metastatic oral tumor from gallbladder cancer has been reported in the literature. We report a rare case of gingival metastasis from an occult gallbladder cancer. [Copyright &y& Elsevier]

The article presents a study which examined the occurrence of gallbladder agenesis in a male Chihuahua with a history of anorexia and vomiting. An exploratory laparotomy and retrograde cholangiography revealed possible hypoplasia of the right medial and lateral liver lobes. The study found that intrahepatic bile ducts in the right medial and lateral lobes were concentrated consistent with the macroscopic observation of the lobes. It reveals that prevention of duodenitis and duodenal ulceration since the buffering effects of bile on gastric acids could be compromised.

Biliary fistula is an infrequently occurring disease in which gall stones pass from the gall bladder to the duodenum causing intestinal obstruction. In most cases the stones' impact is at the end of the small intestine. When the stones impact in the duodenum it is called Bouveret's syndrome. We present a case study of a patient with acute cholecystitis and another case study of Bouveret's syndrome, together with a summary symptoms, diagnostic techniques, and treatment. [ABSTRACT FROM AUTHOR]

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The incidence of villous papilloma of the gallbladder is rarely found amongst children. We report on a 9-year old girl known case of metachromatic leukodystrophy presented with abdominal distension. A radiological examination revealed massive ascites and a papillary mass branching and projecting through the gallbladder fundus. Furthermore, a histopathological examination of the gallbladder showed villous papilloma with focal high-grade dysplasia and a single gallbladder stone. This report describes the rare presentation of a child with metachromatic leukodystrophy in the form of gallbladder polyp, intractable ascites, and a gallbladder stone. [ABSTRACT FROM AUTHOR]

Summary: We reported previously that intestinal metaplasia in the gallbladder is strongly associated with expression of caudal-related homeobox transcription factor Cdx2. It has been documented that occult pancreatobiliary reflux, even in the absence of pancreaticobiliary maljunction, is associated with elevated risk of biliary malignancy. We ascertained the correlation between intestinal metaplasia in the gallbladder and occult pancreatobiliary reflux. In 196 patients with a normal pancreaticobiliary ductal arrangement who had undergone laparoscopic cholecystectomy, we performed intraoperative cholangiography and measured amylase levels in bile sampled from the gallbladder. The cutoff value for high cystic amylase was defined as a biliary amylase level higher than the normal upper limit of serum amylase (215 IU/L). We also retrospectively reviewed the cholecystectomized tissue specimens to investigate the presence of intestinal metaplasia and expression of Cdx2. Then, we explored the relationship between intestinal metaplasia in the gallbladder and occult choledocho-pancreatic reflux. Intestinal metaplasia was found in 16.8% (33/196) of the gallbladders. The prevalence of choledocho-pancreatic reflux revealed by intraoperative cholangiography was not significantly different between cases with intestinal metaplasia (5/33, 15.2%) and those without (25/163, 15.3%; P = .81). However, in cases with intestinal metaplasia, the rate of high cystic amylase (13/33, 39.4%) was significantly higher compared with cases without intestinal metaplasia (26/163, 16.0%, P = .005). In conclusion, intestinal metaplasia in the gallbladder is significantly correlated with high amylase levels in bile in patients with a morphologically normal pancreaticobiliary ductal arrangement. [Copyright &y& Elsevier]

Introduction: Laparoscopic cholecystectomy is a method of choice in the treatment of calculous gallbladder. There is a clear evidence of changes in hemostatic parameters during this surgical procedure, which can result in thromboembolic complications. The aim of the study was to evaluate changes in D-dimer values, as a marker of hypercoagulability in patients treated with laparoscopic cholecystectomy. Patients and methods: The study included total of 60 patients, divided into two groups, one treated with classic (open) and other with laparoscopic method. Blood samples were taken from all patients before, during the surgery and 24 hours and 5 days after the procedure with consequent determination of D-dimer levels. R esults: Blood samples of patients in both groups manifested higher values of D-dimer during the operation, 24 hours and 5 days after the procedure. We have found elevated values of D-dimer 5 days after the surgery in the group of patients treated with laparoscopic cholecystectomy with 2.5 times higher levels compared to values measured preoperatively. C onclusion: Our results suggest that there is an increased fibrinolytic activity after laparoscopic cholecystectomy, which demands more detailed and complete study on tromboembolism prophylaxis. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the ultrasound findings and macroscopic findings of gallbladder examinations in dogs that have undergone cholecystectomy and offers considerations for prognosis. It states that the study used 11 dogs of breeds like Pomeranians and Beagle. It performed histopathological examinations on the gallbladders. The results of the study revealed that 9 of 11 dogs have content-filled gallbladder. It adds that four dogs were distinguished to have features of gallbladder mucocele (GM) in the ultrasound and macroscopic findings. It also mentions that age and white blood cell (WBC) count in the dogs' death cases are predictive factors for prognosis.

Copyright of Collegium Antropologicum is the property of Croatian Anthropological Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Percutaneous cholecystostomy (PC) has been used in the management of acute cholecystitis and biliary sepsis in patients with severe comorbidities where emergency cholecystectomy or open cholecystostomy are considered to carry prohibitive risks of mortality. We reviewed three consecutive cases of elderly patients with biliary sepsis presenting acutely to our unit who were managed successfully with this approach, and present herein these cases and a review of the literature. [Copyright &y& Elsevier]

Gallbladder diseases account for numerous problems related to digestion, and the discomfort they cause affects people worldwide. This article examines various gallbladder diseases, including causes and treatment options. Understanding the gallbladder and its diseases is crucial to achieving an accurate diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Cholecystectomy, which can be performed with either a laparoscopic (LC) or open (OC) approach, remains the definitive treatment for acute cholecystitis (AC) in the United States. There has not been an overall evaluation of the safety and efficacy of LC vs. OC as treatment for AC. Methods: We used the Nationwide Inpatient Sample to identify all patients with AC from 1998-2005. Rates of LC or OC, patient and hospital characteristics, hospital cost, and mortality were analyzed. In order to assess if differences in outcomes exist, propensity scores were created to eliminate differences in cohorts. A case-controlled analysis was then performed, comparing in-hospital mortality and likelihood of conversion to OC. Results: From approximately 1.8 million admissions for AC, 1.4 million patients underwent cholecystectomy (1,240,212 LC; 147,190 OC) for AC from 1998 to 2005. The number of cholecystectomies increased over time. The ratio of LC performed increased from 83% in 1998 to 93% in 2005; 12% of cases were attempted laparoscopically but converted to OC. When compared with OC, patients who underwent LC were more likely to be female, carry private insurance, be discharged to home, have lesser hospital cost per patient, have no comorbid conditions, and have a lesser unadjusted mortality. After adjusting for age, comorbidity and sex, the adjusted odds ratio for death was 4.6-fold greater (95% CI 4.1–5.1) with OC compared with LC as the treatment for AC. Conclusions: LC is performed with increasing frequency as the treatment for AC with lesser mortality, hospital stay, and cost compared with OC. Despite differences in cohorts, these results support a continued aggressive approach with laparoscopy as the treatment of choice for AC. [Copyright &y& Elsevier]

Abstract: Purpose: The aim of this investigation was to establish the association of left-sided gallbladder and right-sided ligamentum teres hepatis with exomphalos and to clarify the portal venous anomaly associated with right-sided ligamentum teres. Methods: Three male infants with exomphalos major associated with left-sided gallbladder and right-sided ligamentum teres hepatis were identified during a retrospective study of exomphalos cases (n = 35) in which exomphalos major comprised 18 cases over 19 years. Results: Three infants with exomphalos major (8.6%) had a left-sided gallbladder and right-sided ligamentum teres hepatis. One male infant survived. Computed tomography showed that there is anomalous intrahepatic portal venous branching associated with right-sided ligamentum teres hepatis. The first branch of the portal vein ran to the right posterior segment, and then the portal vein formed a trunk of the left portal vein and right anterior portal veins. The latter vein formed the umbilical segment of the portal vein and finally joined the ligamentum teres hepatis. The inferior vena cava was on the left side below the kidney and crossed to the right side at the level of the kidney. Conclusions: Left-sided gallbladder with right-sided ligamentum teres hepatis may not be such a rare associated anomaly in infants with exomphalos. However, there are no reports describing this anomaly with exomphalos in the English medical literature. We believe this is the first report. As long-term survival after repair of exomphalos is increasing, perhaps some of the survivors may develop liver disease which requires liver resection later in life. Recognition of this anomalous relationship with exomphalos is clinically important because it is associated with abnormal intrahepatic portal venous branching and intraabdominal vascular anomalies. [Copyright &y& Elsevier]

Abstract: Background: The etiology of chronic acalculous gallbladder dysfunction (CAGD) is unknown. However, cholecystectomy is being performed as treatment, based on gallbladder (GB) ejection fraction studies. The aim of this study was to examine the pathology and immunohistology of GBs from children with CAGD. Methods: Children with a diagnosis of CAGD were identified. Control patients had their GB removed for nonbiliary indications. Immunoperoxidase staining was performed using rabbit antihuman cholecystokinin receptor (CCK-R) antibody. The pathologist was blinded to the study and controls. Results: Fifteen children were evaluated: 6 children with CAGD and 9 controls. All children with CAGD had abnormal cholecystokinin-stimulated nuclear imaging. Ejection fractions ranged from 8% to 30%. All patients reported resolution of symptoms on follow-up at 6 months. Histopathology of the GB was normal for both the controls and children with CAGD. Both control and CAGD GBs demonstrated positive staining for CCK-R in the vascular endothelium and smooth muscle. Mucosal epithelial staining was only observed in 5 of 6 of GBs of children with CAGD. In the sixth GB, the epithelium was too necrotic to assess. Conclusions: In this pilot study, expression of CCK-Rs in the epithelial cells is noted in children with CAGD compared with controls. The significance of this finding requires further investigation. [Copyright &y& Elsevier]