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Background: Acute acalculous cholecystitis (AAC) accounts for 5-10% of cases of acute cholecystitis. The advantage of interval cholecystectomy for patients with AAC is unclear. Therefore, a retrospective analysis of patients diagnosed with AAC at our institution was performed over a 5-year period., Methods: Patients were identified via hospital coding using the keywords "acalculous cholecystitis, cholecystostomy and gall bladder perforation." Follow-up data was obtained by performing a retrospective review of the patients' hospital records., Results: A total of 33 patients with AAC were identified and followed for a median period of 18 months. The median age at presentation was 70 (10-96) and American Society of Anesthesiologists (ASA) grade was 3 (1-5). Twenty-three patients (70%) were treated with antibiotics alone, 7 patients (21%) with percutaneous cholecystostomy and 3 patients (9%) with laparoscopic cholecystectomy. The 90-day mortality rate was 30% with significant correlation to comorbid status, as all deaths occurred in ASA grade 3-5 individuals (p = 0.020). Two patients (6%) developed recurrent AAC and were managed non-operatively., Conclusion: Antibiotics and cholecystostomy were the mainstay of AAC management, and comorbid status influenced related mortality. Our results suggest that it appears safe to avoid interval cholecystectomy in patients who recover from AAC, as they are typically high-risk surgical candidates., (© 2017 S. Karger AG, Basel.)

Aims: Acute acalculous cholecystitis can be treated with percutaneous cholecystostomy in critically ill patients unfit for surgery. However, the evidence on the outcome is sparse. We conducted a retrospective analysis of acute acalculous cholecystitis patients treated with percutaneous cholecystostomy during a 10-year study period., Methods: An observational study of 56 consecutive patients treated with percutaneous cholecystostomy for acute acalculous cholecystitis was conducted in the period from 1 June 2002 to 31 May 2012. All data were obtained by review of medical records., Results: A total of 56 consecutive patients were treated with percutaneous cholecystostomy for acute acalculous cholecystitis. Six patients (10.7%) died within 30 days after the procedure. Percutaneous cholecystostomy could serve as a definitive treatment option in 45 patients (80.4%), whereas 1 patient (1.8%) required cholecystectomy due to recurrence of cholecystitis. Four patients (7.1%) were treated with percutaneous cholecystostomy as a bridging procedure to subsequent elective laparoscopic cholecystectomy within a median of 8.8 months (range: 7.7-33.4 months). There was no significant difference in the risk of cholecystitis recurrence between patients with (6/37) and without (2/3) contrast passage to the duodenum on cholangiography (p = 0.096)., Conclusion: Percutaneous cholecystostomy is successful as a definitive treatment option in the majority of patients with acute acalculous cholecystitis. It is associated with a low rate of mortality and subsequent cholecystectomy., (© The Finnish Surgical Society 2015.)

Acute cholecystitis is defined as inflammation of the gallbladder and is usually caused by obstruction of the cystic duct. Cholescintigraphy is the most sensitive imaging modality for cholecystitis. The gold standard treatment of acute cholecystitis is laparoscopic cholecystectomy. Operating early in the disease course decreases overall hospital stay and avoids increased complications, conversion to open procedures, and mortality. Cholecystitis during pregnancy is a challenging problem for surgeons. Operative intervention is generally safe for both mother and fetus, given the improved morbidity of the laparoscopic approach compared with open, although increased caution should be exercised in women with gallstone pancreatitis., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Diagnostic and therapeutic approaches of acute calculous cholecystitis are well defined. Cholecystectomy is among the most frequently performed surgical interventions. In contrast, acute acalculous cholecystitis is a secondary condition; its cause may be difficult to determine and indication for surgical intervention has not been clearly established. The authors summarize the primary causes of acute acalculous cholecystitis and discuss ultrasonographic features which may help the decision to perform cholecystectomy in patients with acalculous cholecystitis.

The association of appendicitis with synchronous cholecystitis in a child has not yet been reported. Only a few case reports and series have been described involving adults. We describe an 11-year-old female who presented with complaints of right-sided pain abdomen with a history of right inguinal hernia as well. Clinical presentation and imaging were suggestive of calculous cholecystitis, appendicitis, and right inguinal hernia. A single-stage laparoscopic cholecystectomy, appendicectomy, and herniotomy were done using only four standard ports for cholecystectomy with minor modification of port position. The patient had a favorable recovery and had no complications on follow-up. A synchronous association of such common diseases is rare and needs to be kept in mind. [ABSTRACT FROM AUTHOR]

We present a 20 years old male with no known comorbid in emergency complaining of pain localized to the right upper quadrant for two days, followed by fever (101F) with 15-16 episodes of vomiting, which were non-bilious and containing food particles. The patient was vitally stable on examination and had a mild jaundiced look; the abdomen was soft and tender over the right hypochondrium. Ultrasound of the abdomen showed a hypoechoic liver and thick-walled acalculous gall bladder along with pericholecystic fluid, suggesting acute cholecystitis. On further evaluation, the diagnosis of gangrenous cholecystitis was made, and an emergency exploratory laparotomy along with a cholecystectomy was performed. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to demonstrate the impact of laparoscopic cholecystectomy on the physical and mental health of patients with gallbladder dysmotility. Methods: Retrospective data was collected from 314 patients who had undergone a hepatobiliary iminodiacetic acid (HIDA) scan between June 2012 and June 2022 in a District General Hospital in South East England. Sixty‐three patients who were diagnosed with gallbladder dysmotility were then contacted and asked to participate in a telephone interview regarding their symptoms. We measured their health‐related quality of life using the HRQoL SF‐12 v2 (Health Related Quality of Life Short Form‐12 version 2) questionnaire. Differences in the resolution of symptoms between those that had undergone a cholecystectomy and those who did not, were assessed using a chi square test. The two groups were then compared using the student t‐test to assess statistically significant differences. Results: 94% (n = 31/33) of the participants in the non‐cholecystectomy group demonstrated persistent biliary pain symptoms as opposed to the 6% (n = 2/30) in the cholecystectomy group. A statistically significant improvement in five out of the eight domains of the HRQoL SF‐12 questionnaire was demonstrated. These domains include PCS (physical component summary), MCS (mental component summary), mental health, general health and bodily pain. Conclusion: The results of our retrospective analysis demonstrate an improvement in both the physical and mental health‐related quality of life symptoms in patients who underwent laparoscopic cholecystectomy. These findings support the use of laparoscopic cholecystectomy as an effective method for managing gallbladder dysmotility. [ABSTRACT FROM AUTHOR]

Intracholecystic papillary neoplasm (ICPN) of the gallbladder is a relatively new concept and a rare neoplasm. ICPNs are found in 0.4% of cholecystectomies. ICPNs are commonly associated with low-to high-grade dysplasia and can be found with invasive foci. To the best of our research, <100 cases (n = 92) are reported worldwide and only 27 cases have been reported in India. We present a case of ICPN with a detailed review of the literature to illuminate the pitfalls of this entity, which is rarely encountered in routine reporting. [ABSTRACT FROM AUTHOR]

Background: Gallstones are a well-known risk factor for acute cholecystitis. However, their role as a risk factor for gallbladder perforation (GBP) remains unclear. Therefore, this study aimed to determine the effect of gallstones on the development of GBP. Materials and methods: This large-scale retrospective cohort study enroled consecutive patients who underwent cholecystectomy for acute cholecystitis. The primary endpoint was the role of gallstones as a risk factor for developing GBP. Secondary endpoints included the clinical characteristics of GBP, other risk factors for GBP, differences in clinical outcomes between patients with acalculous cholecystitis (AC) and calculous cholecystitis (CC), and the influence of cholecystectomy timing. Results: A total of 4497 patients were included in this study. The incidence of GBP was significantly higher in the AC group compared to the CC group (5.6% vs. 1.0%, P< 0.001). However, there were no differences in ICU admission and hospital stay durations. The incidence of overall complications was significantly higher in the AC group than in the CC group (2.2% vs. 1.0%, P <0.001). Patients with AC had a higher risk of developing GBP than those with CC (odds ratio, 5.00; 95% CI, 2.94-8.33). In addition, older age (≥ 60 years), male sex, comorbidities, poor performance status, and concomitant acute cholangitis were associated with the development of GBP. Furthermore, the incidence of GBP was significantly higher in the delayed cholecystectomy group than in the early cholecystectomy group (2.0% vs. 0.9%, P <0.001). Conclusions: AC is a significant risk factor for GBP. Furthermore, early cholecystectomy can significantly reduce GBP-related morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: The present study was conducted to compare the efficacy and safety of ligature application with metallic clip application for cystic duct ligation in laparoscopic cholecystectomy. Methods: This was a cross-sectional study conducted between May 2021 and May 2022 for a duration of 12 months among patients undergoing laparoscopic cholecystectomy (elective or emergency) for any reason (symptomatic gallstones, acalculous cholecystitis, gallbladder polyp, or any other condition) in the Department of General Surgery, PSG Hospitals, Coimbatore. Patients were assigned to either Group A (cystic duct occlusion with ligatures) or Group B (cystic duct occlusion with metallic clips). Results: The study found significantly less operating time in the clip group compared to the ligature group. The mean clip/ligature time of the ligature group was 12.30 ± 4.36, and that of the clip group was 8.67 ± 2.87. The mean difference in the clip/ligature time between the study groups was statistically significant, with a p-value of <0.001. We found a significantly shorter time to clip the ligation of the cystic duct as compared to the ligature technique. Both groups found all subjects to have no post-op complications or interventions. In both groups, the median hospital stay was 3 days (IQR 2.0 to 3.0), p-value 0.3589. The surgery and post-surgery follow-up of 1 month were uneventful in both groups. Conclusions: Metal clips are frequently used to tie up the cystic duct, but they have their own limitations and complications. There are equally effective alternative methods available. One such method is the simple, safe, and economical suture ligation of the cystic duct. Although the use of ligatures is associated with a longer duct occlusion time and thereby total surgical duration and also needs greater surgical expertise, they can be used as an equivalent alternative to clips, especially in patients with wide and short cystic ducts. [ABSTRACT FROM AUTHOR]

The definition of Early Cholecystectomy (EC) is still debatable. This paper aims to find whether the timing of EC affects outcomes. The article reports a multicentric prospective observational study including patients with acute calculous cholecystitis (ACC) who had cholecystectomy within ten days from the onset of symptoms. Kruskall-Wallis test, Fisher's Exact test, and Spearman rank correlation were used for statistical analysis. The patients were divided into three groups depending on the timing of the operation: 0–3 days, 4–7 days, or 8–10 days from the onset of symptoms. 1117 patients were studied over a year. The time from the onset of symptoms to EC did not affect the post-operative complications and mortality, the conversion, and the reintervention rate. The time represented a significant risk factor for intraoperative complications (0–3 days, 2.8%; 4–7 days, 5.6%; 8–10 days, 7.9%; p = 0.01) and subtotal cholecystectomies (0–3 days, 2.7%; 4–7 days, 5.6%; 8–10 days, 10.9%; p < 0.001). ACC is an evolutive inflammatory process and, as the days go by, the local and systemic inflammation increases, making surgery more complex and difficult with a higher risk of intraoperative complications. We recommend performing EC for ACC as soon as possible, within the first ten days of the onset of symptoms. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing 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.)

Acute acalculous cholecystitis has been associated with critically ill and elderly patients.In the pediatric population, the etiology of this pathology could be an uncommon but potentially significant complication of Epstein-Barr virus infection. This virus is very common in young adults and is associated with fatigue, muscle aches, fever, and in some instances can present with transaminitis and jaundice. This transient hepatocellular injury could lead to gallbladder inflammation. We are going to present our experience and treatment in two patients that presented with abdominal pain and a positive mononucleosis test.

Background and aims: Acute calculous cholecystitis (ACC) represents about one-third of all surgical emergencies. The gold standard management of ACC is laparoscopic cholecystectomy. Although cholecystectomy is a safe procedure, it may be dangerous and contraindicated in patients with complex comorbidities. Endoscopic transpapillary gallbladder stenting (ETGBS) and drainage had been widely used to manage patients suffering from ACC with comorbidities. Methods: We searched PubMed, SCOPUS, Web of Science, and Cochrane Library for relevant studies assessing the use of ETGBS in patients suffering from ACC with various comorbidities. Risk of bias assessment was performed using the National Institues of Health (NIH) tool. We included the following outcomes: clinical success, technical success, late complications, and pancreatitis. Results: We included seven studies that met our inclusion criteria. We found that the pooled proportion of clinical success, technical success, late complications, and pancreatitis was [91.3%, 95% confidence interval (CI) (86.8%, 95.9%)], [92.8%, 95% CI (89%, 96.5%)], [5.4%, 95% CI (2.9%, 7.9%)], and [3.5%, 95% CI (1.2%, 5.8%)], respectively. Conclusion: We found that an ETGBS was an effective and well-tolerated method for the treatment of cholecystitis, especially in high-risk individuals. [ABSTRACT FROM AUTHOR]

Copyright of Enfermería Investiga: Investigaciin, Vinculación, Docencia y Gestiin is the property of Revista Enfermeria Investiga 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.)

Background: Acute acalculous cholecystitis (AAC) is often diagnosed in critically ill patients. Percutaneous cholecystostomy tube (PCT) placement facilitates less invasive gallbladder decompression in patients who are poor surgical candidates. Specific guidelines for optimal management of AAC patients following PCT placement remain to be defined. We hypothesize that AAC patients are at lower risk of recurrent cholecystitis than acute calculous cholecystitis (ACC) patients and do not require cholecystectomy after PCT placement. Methods: A retrospective review of patients who underwent PCT placement for AAC or ACC between 6/1/2007 and 5/31/2019 was performed. Primary outcome was recurrent cholecystitis and interval cholecystectomy for patients surviving 30 days after PCT placement. Secondary outcome was 30 day mortality. A cox regression model calculated the adjusted hazard ratio (AHR) for the outcomes. Results: Eighty-four AAC and 85 ACC patients underwent PCT placement. Compared to ACC patients, more AAC patients were male (72.6 vs. 48.2%; p < 0.01), younger (median age 62 vs. 73 years; p < 0.01), and required intensive care (69.0 vs. 52.9%; p = 0.04), with lower median Charlson Comorbidity Index (4.0 vs. 6.0; p < 0.01). 30 day mortality was higher among AAC patients than ACC patients (45.2 vs. 21.2%; p < 0.01). 2/24 (8.3%) AAC patients and 5/31 (16.1%) ACC patients developed recurrent cholecystitis at a median 208.0 days (IQR:64.0–417.0) after PCT placement and 115.0 days (IQR:7.0–403.0) following PCT removal. Cox regression analysis demonstrated that AAC patients had lower likelihood of interval cholecystectomy compared to ACC patients (AHR 2.35; 95% CI:1.11,4.96). Conclusion: Recurrent cholecystitis is rare in patients surviving 30 days following PCT placement. When compared with ACC patients, fewer AAC patients require cholecystectomy. [ABSTRACT FROM AUTHOR]

A 44-year-old female patient presented with weight loss, diarrhea and intermittent episodes of left upper quadrant (LUQ) pain lasting for 3 years, accompanied by acute episodes of focal LUQ pain, dizziness, tachycardia, borborygmi and bloating, occurring approximately 60 min after meals. The patient developed chronic acalculous cholecystitis and transient exocrine pancreatic insufficiency after infection with Coxsackievirus B4 (CVB4), which resolved following laparoscopic cholecystectomy 2 years before the current presentation. Although imaging and functional investigation studies were unremarkable, a gastric transit study revealed rapid clearance of radiolabeled food, and the patient's symptomatology and gastrointestinal studies supported the diagnosis of late dumping syndrome. The patient's symptoms significantly improved with adherence to recommended dietary changes, including an increase in protein intake, abstinence from simple carbohydrates and avoidance of simultaneous consumption of beverages with food, following consultation with a dietitian. [ABSTRACT FROM AUTHOR]

Background: Cholelithiasis is 7 times more frequent in North India, with an overall incidence of about 2-29%. The number and different morphology of gallstones can cause alterations in the gallbladder (GB) mucosa. GB mucosal change depends on the duration of cholelithiasis, size, number, type of stone, and the gender of the patient. The coexistence of gallstones with cholecystitis, hyperplasia, intestinal metaplasia, and carcinoma is well known in the literature. Incidental gallbladder (GB) carcinoma is revealed in 1% of all cholecystectomies done for benign conditions. The pathological stage of the disease decides the prognosis of the disease. Aims and Objectives: Gallstones are known to produce various histopathological changes in the GB. We aim to correlate gallstone characteristics such as (number and morphological type) with the type of mucosal response in the GB (inflammation, hyperplasia, metaplasia, and carcinoma). Materials and Methods: A study of gallstones was done in 184 cases of open cholecystectomies based on the histological changes. One hundred and sixty-five (89.95%) were associated with gallstones, and the rest 19 cases (10.05%) were of acalculous cholecystitis. The changes in the mucosa of the calculous GB (165 cases) were studied, and the correlation between the mucosal changes and the number and type of stones was evaluated. Tissue sections for histopathological studies were taken from the fundus, body, neck, and abnormal-looking areas of the GB. Results: A gender study revealed a higher incidence of inflammatory changes in males, while GB hyperplasia, intestinal metaplasia, and cancer were found only in females. Conclusion: Correlation of mucosal changes with a number, duration of disease, and morphological type of stones has suggested that there could be an association with the various GB mucosal changes such as inflammation, hyperplasia, metaplasia, and carcinoma of the GB. [ABSTRACT FROM AUTHOR]

Acute cholecystitis is a common disease treated with laparoscopic cholecystectomy as a standard procedure. Perforated cholecystitis is a complication of acute cholecystitis and patients with comorbidities who have a high risk for the operation may also be treated with percutaneous cholecystostomy. The procedure may also be applied for the selected patients with perforated cholecystitis who have a delayed admission to the health institution or who are irresponsive to antibiotherapy. The aim of the present study is to investigate the clinical outcomes and data of the acute cholecystitis patients who underwent percutaneous cholecystostomy. Twentyfour patients who underwent percutaneous cholecystostomy with the diagnosis of perforated acute calculous cholecystitis between October 2012 and February 2020 were included in the study. Diagnosis of acute cholecystitis was made based on the Tokyo Criteria. Patient data were reached through a retrospective screening. Of the total of 24 patients, 70.8% were males. Mean age was 63.3±12.9 years and mean duration of hospital stay was 13.0±9.4 days. All patients were grade 2 according to Tokyo 2018 severity stratification. Mean duration of catheter stay was 37.7±25.3 days. Fifteen patients (62.5%) underwent cholecystectomy. Ratio of complications was 16.7% and catheter dislocation (n=2) was the most common complication. Mean duration of follow-up was 1 year. No patients developed acute cholecystitis on follow-ups, one patient developed acute cholangitis. Mortality rate was calculated for 60 days and no mortality was detected. High risk patients with comorbid conditions may be safely treated with percutaneous cholecystostomy as perforated cholecystitis increases mortality and morbidity in patients with acute cholecystitis. [ABSTRACT FROM AUTHOR]

Acute cholecystitis (AC), defined as inflammation of the gallbladder, is mainly caused by gallstones. Over 90% of AC results from obstruction of the cystic duct by stones or sludge, which subsequently increases the intraluminal pressure within the gallbladder and, in conjunction with the presence of bile supersaturated with cholesterol, activates an acute inflammatory cascade. Clinical features play an important role in the diagnosis of AC. The Tokyo Guidelines 2018 for acute cholecystitis designates the presence of local inflammatory signs and systemic inflammatory signs for a suspected diagnosis. It requires confirmation by radiological imaging along with these two factors for a definitive diagnosis. Thanks to less invasiveness, easy availability, ease of use, and cost-effectiveness, ultrasound (US) is usually accepted as the first choice in suspicious AC patients. A meta-analysis comparing methods of diagnosis for AC reported that the US has 81% of sensitivity and 83% of specificity. Abdominal computed tomography is recommended for diagnosing emphysematous or gangrenous cholecystitis. Meanwhile, acute acalculous cholecystitis (AAC) is a life-threatening disease mainly in severely ill patients. It usually affects the patients hospitalized for multiple trauma, burns, cardiopulmonary bypass surgery, long-term total parenteral nutrition or sepsis. The diagnosis of AAC is quite challenging and requires a high index of suspicion. Currently, cholecystectomy is the treatment of choice for AC, although the optimal time for surgery is still controversial. Due to high morbidity and mortality in high surgical risk groups, percutaneous gallbladder drainage can be a safe and feasible alternative to cholecystectomy, particularly for patients unfit for the surgery. [ABSTRACT FROM AUTHOR]

Background: In this study, we aimed to investigate risk factors for the relapse of moderate and severe acute acalculous cholecystitis (AAC) patients after initial percutaneous cholecystostomy (PC) and to identify the predictors of patient outcomes when choosing PC as a definitive treatment for AAC.Materials and Methods: The study population comprised 44 patients (median age 76 years; range 31-94 years) with moderate or severe AAC who underwent PC without subsequent cholecystectomy. According to the results of follow-up (followed for a median period of 17 months), the data of patients with recurrence versus no recurrence were compared. Patients were divided into the death and non-death groups based on patient status within 60 days after PC.Results: Twenty-one (47.7%) had no recurrence of cholecystitis during the follow-up period after catheter removal (61-1348 days), six (13.6%) experienced recurrence of cholecystitis after PC, and 17 (38.6%) patients died during the indwelling tube period (5-60 days). The multivariate analysis showed that coronary heart disease (CHD) or congestive heart failure (odds ratio [OR] 26.50; 95% confidence interval [CI] 1.21-582.06; P = 0.038) was positively correlated with recurrence. The age-adjusted Charlson comorbidity index (OR 1.53; 95% CI 1.08-2.17; P = 0.018) was independently associated with 60-day mortality after PC.Conclusions: Our results suggest that CHD or congestive heart failure was an independent risk factor for relapse in moderate and severe AAC patients after initial PC. AAC patients with more comorbidities had worse outcomes. [ABSTRACT FROM AUTHOR]

Gallbladder stones (GBS) has been identified in the mummy of an Egyptian priestess dated back to about 1500 BC. It presents in approximately 10-15% of the adult population with approximately 20% of these patients experiencing some form of symptoms. Of those experiencing symptoms approximately 3.4 % to 18.8% will eventually have coexisting common bile duct stones (choledocholithiasis or CBDS). The incidence of choledocholithiasis in patients with cholelithiasis increases with age. Laparoscopic Cholecystectomy (LC) is a minimally invasive surgical procedure for removal of a diseased GB. This technique essentially has replaced the open technique for routine cholecystectomies since the early 1990s. At this time LC is indicated for the treatment of cholecystitis (acute/chronic), symptomatic cholelithiasis, biliary dyskinesia, acalculous cholecystitis, gallstone pancreatitis, and GB masses/polyps. These indications are the same for an OC. [ABSTRACT FROM AUTHOR]

Background: Percutaneous cholecystostomy (PC) with interval cholecystectomy is an effective treatment modality in high-risk patients with acute cholecystitis. However, some patients still fail to undergo interval cholecystectomy after PC, with the reasons rarely reported. Hence, this study aimed to explore the factors that prevent a patient from undergoing interval cholecystectomy.Methods: Data from patients with acute cholecystitis who had undergone PC from January 1, 2017 to December 31, 2019 in our hospital were retrospectively collected. The follow-up endpoint was the patient undergoing cholecystectomy. Patients who failed to undergo cholecystectomy were followed up every three months until death. Univariate and multivariate analyses were performed to analyze the factors influencing failure to undergo interval cholecystectomy. A nomogram was used to predict the numerical probability of non-interval cholecystectomy.Results: Overall, 205 participants were identified, and 67 (32.7%) did not undergo cholecystectomy during the follow-up period. Multivariate analysis revealed that having a Tokyo Guidelines 2018 (TG18) grade III status (odds ratio [OR]: 3.83; 95% confidence interval [CI]: 1.27-11.49; p = 0.017), acalculous cholecystitis (OR: 4.55; 95% CI: 1.59-12.50; p = 0.005), an albumin level < 28 g/L (OR: 4.15; 95% CI: 1.09-15.81; p = 0.037), and a history of malignancy (OR: 4.65; 95% CI: 1.62-13.37; p = 0.004) were independent risk factors for a patient's failure to undergo interval cholecystectomy. Among them, the presence of a history of malignancy exhibited the highest influence in the nomogram for predicting non-interval cholecystectomy.Conclusions: Having a TG18 grade III status, acalculous cholecystitis, severe hypoproteinemia, and a history of malignancy influence the failure to undergo cholecystectomy after PC in patients with acute cholecystitis. [ABSTRACT FROM AUTHOR]

Background: Percutaneous cholecystostomy is performed by interventional radiologists for patients with calculous/acalculous cholecystitis who are poor candidates for cholecystectomy. Two anatomical approaches are widely utilized: transperitoneal and transhepatic. Purpose: To compare the clinical outcomes of transperitoneal and transhepatic approaches to cholecystostomy catheter placement. Material and Methods: From December 2007 to August 2015, 165 consecutive patients (97 men, 68 women) underwent either transperitoneal (n = 89) or transhepatic (n = 76) cholecystostomy at a single center. Indications were calculous cholecystitis (n = 21), acalculous cholecystitis (n = 35), hydrops (n = 1), gangrenous cholecystitis (n = 1), and other cholecystitis (n = 107). The most common high-risk co-morbidities were sepsis (n = 53) and cardiac (n = 11). Outcomes were compared using univariate and multivariable analysis. Results: Post-procedure outcomes included tube dislodgement (transperitoneal [n = 6] and transhepatic [n = 3], P = 0.44), bile leak (transperitoneal [n = 5], transhepatic [n = 1], P = 0.14), gallbladder hemorrhage (transperitoneal [n = 2]; transhepatic [n = 3], P = 0.52), duodenal fistula (transperitoneal [n = 0], transhepatic [n = 1], P = 0.27), repeat cholecystostomy (transperitoneal [n = 1], transhepatic [n = 3], P = 0.27), and repeat cholecystitis requiring separate admission (transperitoneal [n = 6], transhepatic [n = 10], P = 0.15). All complications were Common Terminology Criteria for Adverse Events grade <3. Twenty transperitoneal patients underwent post-procedure cholecystectomy: 13 laparoscopic, three open, and four unclear/outside records. The mean time from cholecystostomy to operation was 38 days (range 3–211 days). Twenty-three transhepatic patients underwent cholecystectomy: 14 laparoscopic, eight open, and one unclear/outside records, with the mean time from cholecystostomy being 98 days (range 0–1053 days). One transhepatic and three transperitoneal patients died during admission. Conclusion: There were no significant differences in short-term complications after transperitoneal and transhepatic approaches to percutaneous cholecystostomy catheter placement. [ABSTRACT FROM AUTHOR]

BACKGROUND: The purpose of the study was to review the efficacy, safety, and outcomes of percutaneous cholecystostomy (PC) in elderly patients with acute calculous cholecystitis (ACC), high comorbidity, and COVID-19. METHODS: The hospital registry data were examined of patients aged >65 years who were diagnosed with ACC and COVID-19 between March 2020 and June 2020 and who underwent PC treatment in the interventional radiology unit. RESULTS: A total of 18 patients were diagnosed with ACC and COVID-19, then underwent PC. The patients comprised 14 (78%) males and 4 (22%) females with an average age of 73.4 years (range, 67-81 years). In 17 (94%) patients, symptoms associated with acute cholecystitis decreased within 48-72 h of the PC treatment and a clinical improvement was determined. The success rate of PC was 100% and no complications. In 3 (16.6%) patients followed up with intubation in intensive care after the procedure, mortality developed due to COVID-19-associated pneumonia and subsequent acute respiratory distress syndrome, and 15 (83.4%) patients were discharged with an elective cholecystectomy plan. CONCLUSION: COVID-19 infection can be fatal especially in patients over 65 years of age due to additional comorbidities. PC treatment, which can be performed under local anesthesia as a minimally invasive procedure, is an alternative treatment option in this patient group. PC can also act as a bridge in transition to elective surgery in this process management. [ABSTRACT FROM AUTHOR]

Acute acalculous cholecystitis accounts for only 5-10% of cholecystitis cases and is often associated with severe trauma, critical illness, or chronic disease. Our case describes an otherwise healthy 25-year-old female presenting with acute abdominal pain. After undergoing a magnetic resonance cholangiopancreatography and cholescintigraphy she was diagnosed with acute acalculous cholecystitis. Her symptoms resolved following laparoscopic cholecystectomy which highlights the importance of prompt diagnosis and treatment of acalculous cholecystitis even in the absence of trauma or critical illness. [ABSTRACT FROM AUTHOR]

We report the rare case of an acalculous, gangrenous cholecystitis on a, previously healthy, outpatient COVID-19 adult. The 53-year-old patient presented to the emergency department due to epigastric pain and fever and was admitted to the COVID-19 department. Due to clinical and laboratory deterioration, a computed tomography scan was performed that confirmed the diagnosis of acalculous cholecystitis. The patient was submitted to laparoscopic cholecystectomy. Intraoperatively, a gangrenous gallbladder was identified. Immunohistology validated the presence of specimen wall vasculitis and vessel thrombosis. [ABSTRACT FROM AUTHOR]

Background: In elderly patients with calculous acute cholecystitis, the risk of emergency surgery is high, and percutaneous cholecystostomy tube drainage (PC) combined with delayed laparoscopic cholecystectomy (DLC) may be a good choice. We retrospectively compared laparoscopic cholecystectomy (LC) to DLC after PC to determine which is the better treatment strategy.Method: We performed a retrospective cohort analysis of 752 patients with acute calculous cholecystitis. Patients with the following conditions were included: (1) age > 65 years old; (2) patients with a grade 2 or 3 severity of cholecystitis according to the 2013 Tokyo Guidelines (TG13); (3) the surgeons who performed the LC were professors or associate professors and (4) the DLC was performed in our hospital after PC. Patients who missed their 30-day follow-up; were diagnosed with bile duct stones, cholangitis or gallstone pancreatitis or were pregnant were excluded from the study. A total of 51 of 314 patients who underwent LC and 73 of 438 patients who underwent PC + DLC were assessed. PC + DLC and LC patients were matched by cholecystitis severity grade according to the TG13, and the National Surgical Quality Improvement Program (NSQIP) calculator was used to predict mortality (n = 21/group). Preoperative characteristics and postoperative outcomes were analysed.Results: Compared to the matched LC group, the DLC group had less intraoperative bleeding (42.2 vs 75.3 mL, p = 0.014), shorter hospital stays (4.9 vs 7.4 days, p = 0.010) and lower rates of type A bile duct injury (4.8% vs 14.3%, p = 0.035) and type D (0 vs 9.5%, p = 0.002) according to Strasberg classification, residual stones (4.8 vs 14.3%, p = 0.035) and gastrointestinal organ injury (0 vs 3.6%, p < 0.001). Patients in the DLC group had lower incidences of ICU admission and death and a significantly lower incidence of repeat surgery.Conclusion: In elderly patients treated for acute calculous cholecystitis, the 30-day mortality and complication rates were lower for PC + DLC than for LC. However, the total hospitalisation time was significantly prolonged and the costs were significantly higher for PC + DLC. [ABSTRACT FROM AUTHOR]

Objective: To determine if an association hypercholesterolemia and cholesterolosis or gallbladder lithiasis does exist. Methods: AA case series study was conducted between January 2014 and December 2015 in Hospital Belén, Trujillo-Perú. Patients were those in whom a cholecystectomy had been performed (1069) and a lipid profile was available (143). Results: Age range was 17-95 years with a mean age of 50; 36 (25.2%) had cholesterolosis, male to female ratio was 1.2,6. Gallbladder lithiasis was found in 119 cases (83.2%), male to female ratio is 1.3.1 and a mean age of 48. Hypercholesterolemia (≥ 200 mg/dl) was found in 51 cases (35.7%); 29 20.3% cholesterolosis with gallbladder lithiasis and 7 (4.9%) had acalculous cholesterolosis. No association was found between hypercholesterolemia and cholesterolosis (p=0.284) nor with gallbladder lithiasis (p=0.169). Conclusions: No significant association between hypercholesterolemia and cholesterolosis or gallbladder lithiasis was found. [ABSTRACT FROM AUTHOR]

Introduction: Hepatobiliary iminodiacetic acid (HIDA)-radionuclear scans are used to diagnose biliary dyskinesia, the treatment for which is a laparoscopic cholecystectomy (LC). However, the predictive value of the HIDA scan for LC candidacy is debated. Case: A physical, ultrasound, and blood test for a 53-year-old woman with biliary dyskinesia-like symptoms were normal, contradicting a textbook history. A HIDA- scan was ordered but the results suggested she was not eligible for a LC. The patient insisted on receiving the procedure and gave informed consent to undergo an elective LC. Results: Six-weeks post-surgery, the patient's symptoms had ceased besides one short episode of abdominal pain. Conclusion: A LC relieved the patient's symptoms, suggesting that negative HIDA-scans can mislead correct decisions to perform a LC. Surgeons who receive inconclusive HIDA scan results should consult their patients, and when necessary and agreed-upon, take an informed risk together in an attempt to improve the patient's quality of life. [ABSTRACT FROM AUTHOR]

Summary: Background: Gallbladder dyskinesia (gallbladder spasm, biliary dyskinesia or chronic acalculous cholecystitis) is a poorly defined entity which presents as biliary‐type pain without any identifiable organic pathology. Abnormal gallbladder ejection fraction (GBEF) is used by some to select those likely to benefit from cholecystectomy. The validity of this approach has been questioned. Aim: To systematically review the literature and summarise the evidence surrounding the practice of cholecystectomy based on GBEF for gallbladder dyskinesia. Methods: We conducted a systematic search of PubMed/MEDLINE and SCOPUS from 1980 to 2016 to identify the relevant literature. Results: Twenty‐nine studies including 2891 patients were included in the final analysis. In comparing cholecystectomy with medical management, patients with a normal GBEF did not benefit from cholecystectomy; whereas those with low GBEF had a higher chance (RR, relative risk = 2.37) of symptomatic improvement following surgery. When those classified as "low" and "normal" GBEF were compared in terms of outcome following cholecystectomy, the rate of improvement following surgery was similar in the two groups (RR 1.09) which suggests a placebo effect of surgery. Conclusions: While a low GBEF may provide some guidance in identifying those with gallbladder dyskinesia who may benefit from cholecystectomy, the available data are inconsistent and based on studies of poor quality which are often subject to bias and the impact of confounding factors. For these reasons, we conclude that the role of scintigraphy and cholecystectomy in the definition and management of this disorder remain unclear pending definitive study. [ABSTRACT FROM AUTHOR]

The recent increase in measles cases will result in a higher incidence of associated complications. Hepatobiliary complications are among rare complications of measles. Here, we present a case of measles complicated by acute acalculous cholecystitis (AAC), which we believe to be only the second case reported in the literature. A 17-year-old woman presented with a maculopapular rash, high fever, sore throat, runny nose, nausea, and generalized body aches. Measles was diagnosed by anti-measles immunoglobulin M (IgM) positivity and a 4-fold increase in immunoglobulin G (IgG) 2 weeks later. On day 5, Murphy's sign was positive and antibiotic therapy was initiated. Two days later, laparoscopic cholecystectomy was performed due to persistent fever and abdominal pain. The pathology result was consistent with nonspecific cholecystitis. As this case highlights, it should be kept in mind that AAC, which is a rare complication of the multisystem involvement caused by measles, can occur during recovery from the infection. [ABSTRACT FROM AUTHOR]

Haemorrhagic cholecystitis is a seldom seen cause of right upper quadrant pain that can result in gallbladder rupture, massive intraperitoneal haemorrhage and death if untreated. Haemorrhagic cholecystitis is usually seen in the presence of cholelithiasis, malignancy, trauma and coagulopathies. Here, we present the unusual case of an elderly man presenting with acalculous haemorrhagic cholecystitis, who was successfully treated with laparoscopic cholecystectomy. We review the radiological and laparoscopic findings of haemorrhagic acalculous cholecystitis. This case highlights the importance of prudent use of radiological imaging to differentiate haemorrhagic cholecystitis from alternate pathology and early surgical intervention to avoid massive intraperitoneal haemorrhage and the high mortality with which it is associated. [ABSTRACT FROM AUTHOR]

Gallstones are a worldwide medical problem. TNF-á are vital cytokines, it can make the gallbladder inflammation is more by it directly affected gallbladder epithelial cell absorptive function contribute to hastening gallstone formation. However, IL-4 protects gallstone production. A recent study was performed on patients with chronic cholecystitis (acalculous and calculus type) ten tissue samples of chronic acalculous cholecystitis and ninety-five tissue sample from calculus patient can be referred to the surgical clinic of Al-Husain General Hospital. Gallbladder tissue sample put in formalin then transport to the laboratory for examination the expression status of these cytokines in gallbladder tissue by IHC technique and modern spatial visualization technique. There is a significant statistical difference between calculus and a calculous cholecystitis with TNF-á and IL-4 expression. Expression of IL4 and TNF-á have a role in the cholelithiasis pathogenesis and gallstone pathogenesis. [ABSTRACT FROM AUTHOR]

Objectives: Indications for cholecystectomy have changed dramatically over the past three decades. Cystoisospora belli has been reported in cholecystectomy specimens of immunocompetent patients. The present study was designed to determine the prevalence and clinical association of C belli in the gallbladder.Methods: The study included retrospective review of cholecystectomy specimens (n = 401) removed for various indications, and a prospective cohort of cholecystectomy specimens (n = 22) entirely submitted for histologic evaluation. Correlations of presence of C belli with age, sex, clinical indication, and abnormalities of preoperative laboratory values were assessed by Fisher exact test.Results: C belli was identified in 39/401 (9.7%) of the retrospective cohort, and 6/22 (27.3%) of the entirely submitted specimens. The presence of C belli showed no correlation with age, sex, clinical indication, or laboratory abnormalities.Conclusions: C belli resides in a latent state in the gallbladder and may be best considered a commensal organism. [ABSTRACT FROM AUTHOR]

Abstract Background Percutaneous cholecystostomy (PC) tube is a preferred option in acute cholecystitis for patients who are high risk for cholecystectomy (CCY). There are no evidence-based guidelines for patient care after PC. We identified the predictors of disease recurrence and successful interval CCY. Methods A retrospective review of 145 PC patients between 2008 and 2016 at a tertiary hospital was performed. Primary outcomes included mortality, readmissions, hospital and intensive care unit length of stay (LOS), disease recurrence, and interval CCY. Results There were 96 (67%) calculous and 47 (33%) acalculous cholecystitis cases. Seventy-two (49%) had chronic and 73 (51%) had acute prohibitive risks as an indication for PC. There were 54 (37%) periprocedural complications, which most commonly were dislodgements. Twenty-six (18%) patients had a recurrence at a median time of 65 days. Calculous cholecystitis (odds ratio [OR] 3.44, P = 0.038) and purulence in the gallbladder (OR 3.77, P = 0.009) were predictors for recurrence. Forty-one (28%) patients underwent interval CCY. Patients with acute illness were likely to undergo interval CCY (OR 6.67, P = 0.0002). Patients with acalculous cholecystitis had longer hospital LOS (16 versus 8 days) and intensive care unit LOS (2 versus 0 days), and higher readmission rates (OR 2.42, P = 0.02). Thirty-day mortality after PC placement was 9%. Patients receiving interval CCY were noted to have increased survival compared to PC alone. However, this should not be attributed to interval CCY alone in absence of randomization in this study. Conclusions Calculous cholecystitis and purulence in the gallbladder are independent predictors of acute cholecystitis recurrence. Acute illness is a strong predictor of successful interval CCY. The association of interval CCY and prolonged survival in patients with PC as noted in this study should be further assessed in future prospective randomized trials. [ABSTRACT FROM AUTHOR]

Background: While evidence supports early compared to delayed cholecystectomy as optimal management of acute calculous cholecystitis (ACC), significant variability in practice remains. The purpose of this study was to identify variables associated with early cholecystectomy, to target opportunities to improve adherence to best practices.Methods: Adult patients admitted to surgical units with ACC at two hospitals in a university hospital network between June 2010 and January 2015 were reviewed. Patients with concurrent pancreatitis, cholangitis or severe ACC (with organ system failure) were excluded. Early cholecystectomy was defined as surgery performed during same admission and within 7 days of presentation. Non-operative management was defined as admission for ACC treated conservatively, with or without eventual delayed cholecystectomy. The primary outcome was early cholecystectomy versus initial non-operative management; secondary outcomes included time to cholecystectomy, complications, and total hospital length of stay (LOS).Results: A total of 374 patients were included. Two hundred and forty six patients (66%) underwent early cholecystectomy, 60 (16%) were treated non-operatively and had delayed cholecystectomy, and 68 (18%) were only treated non-operatively. Median time to OR from initial presentation was 38 h [22-63] for early cholecystectomy patients and 69 days [29-116] for the non-operative patients who had delayed cholecystectomy. When comparing both groups, early cholecystectomy patients were younger and were treated more often at site 1. There were no differences in complications during hospitalization, but early cholecystectomy patients had a lower median total LOS (3 [2-5] vs. 5 [4-9], p < 0.001), and they had fewer gallstone-related events after discharge (1 vs. 18%, p < 0.001). On multiple logistic regression analysis, lower age, hospital site and lower risk of concurrent choledocholithiasis were all significantly associated with early cholecystectomy (p < 0.05).Conclusion: Our data supports early cholecystectomy as best practice in management of ACC with no differences in complications during hospitalization, shorter median LOS and fewer gallstone-related events compared to non-operative management. We identified patient and institutional factors associated with early cholecystectomy. This suggests that multiple strategies will be necessary to promote adherence to best practices in the management of ACC within our institution. [ABSTRACT FROM AUTHOR]

Acute acalculous cholecystitis in trauma patients is an elusive diagnosis, more so if the patient sustained blunt abdominal trauma. It can arise as a post-traumatic or postsurgical complication, occurring more in critically ill patients. A high index of suspicion for acalculous cholecystitis must be maintained for critically ill patients with newly developing symptoms or septicaemia. We describe a case of a 27-year-old male patient who sustained blunt abdominal trauma in a road traffic accident. He had at least grade III liver injury and later developed gangrenous acalculous cholecystitis, which was confirmed histopathologically after open cholecystectomy. [ABSTRACT FROM AUTHOR]