Search

Copyright of Revista Latinoamericana de Hipertension is the property of Revista Latinoamericana de Hipertension 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.)

Chronic cholecystitis is a common disease that causes inflammation in the gallbladder and is usually associated with gallstones. Laparoscopic cholecystectomy has been widely used as a minimally invasive surgical technique to treat this condition. However, the clinical effect of laparoscopic cholecystectomy in the treatment of chronic cholecystitis with gallstones needs further investigation. This study aimed to investigate the clinical effect of laparoscopic cholecystectomy in treating chronic cholecystitis with gallstones. 90 patients with chronic cholecystitis and gallstones were randomly divided into control and research groups. The control group underwent traditional open cholecystectomy, while the research group received laparoscopic cholecystectomy. Perioperative indexes, oxidative stress indexes, serum inflammatory factors, liver function indexes and the incidence of complications were observed and compared. Results showed that laparoscopic cholecystectomy significantly reduced the operation time, blood loss, anal exhaust time, abdominal pain duration, and hospital stay compared to traditional open cholecystectomy (P < 0.05). Moreover, laparoscopic cholecystectomy significantly reduced the levels of oxidative stress indexes (GSH-Px), inflammatory factors (IL-6, TNF-α, and CRP), and liver function indexes (TBIL, AST, and ALT) compared to traditional open cholecystectomy. Moreover, the complication rate of the research group was significantly lower than that of the control group (P < 0.05). In conclusion, laparoscopic cholecystectomy for chronic cholecystitis with gallstones is a safe and effective procedure that reduces the perioperative stress response and promotes the rapid recovery of the postoperative body. The findings of this study provide a basis for the clinical promotion of laparoscopic cholecystectomy as the preferred surgical treatment for chronic cholecystitis with gallstones. [ABSTRACT FROM AUTHOR]

BACKGROUND: Chronic calculous cholecystitis is the most widespread disease in scheduled surgery departments, which in 10–15% of observations is complicated by choledocholithiasis. As of today, the commonly acknowledged staged treatment tactics includes first an endoscopic lithoextraction, later followed by the laparoscopic cholecystectomy, with the durations of performing the latter not being defined. AIM: To define the optimal timings of performing the laparoscopic cholecystectomy after an endoscopic lithoextraction in cases of chronic calculous cholecystitis, complicated by choledocholithiasis. METHODS: The research included patients with chronic calculous cholecystitis, complicated by choledocholithiasis, which during the period of 2016–2023 years have received surgical aid at the Federal State Budgetary Institution “Federal Scientific and Clinical Center” of the Federal Medical-Biological Agency of Russia (n=87). Simultaneous endoscopic lithoextraction and laparoscopic cholecystectomy were carried out in 20 patients; 19 patients were operated within a single hospitalization with undergoing endoscopic lithoextraction and in 3 days — laparoscopic cholecystectomy (early cholecystectomy); in 48 patients laparoscopic cholecystectomy was delayed by 1–2 months after the endoscopic lithoextraction (interval cholecystectomy). RESULTS: When comparing the treatment results in three groups of patients, no statistically significant differences were observed, however, in the group of interval cholecystectomy, a tendency was shown for increasing the surgery duration, the conversion rate and the number of complications. CONCLUSION: In patients, not having signs of severe course of the disease, it is possible to perform simultaneous endoscopic lithoextraction and laparoscopic cholecystectomy. In the absence of complications, the applicable options include early (within 3 days) conducting the laparoscopic cholecystectomy, which does not worsen the results, however, it alleviates the necessity of repeated hospitalization and, probably, slightly decreases the risk of complications.

Objective: NOTES gallbladder‐preserving surgery (N‐GPS) has been heralded as a new paradigm shift in minimally invasive surgery for chronic cholecystitis patients. The objective of this research was to evaluate the impact of N‐GPS on the intestinal microbiota of patients. Methods: The study selected patients with benign gallbladder disease (BG group) within 1 week preoperative (BG_DPR stage) and followed up over 1 year postoperative (BG_YPO stage) and selected healthy controls (HC group) whose sex, age, and BMI index matched with patients at BG_YPO stage, too. Accordingly, stool samples from healthy controls and two stages of patients with benign gallbladder disease were collected; among them, the selected samples were sent for 16S rDNA sequencing with Illumina MiSeq platform, and then, the combined samples were sent for short‐chain fatty acid (SCFA) analysis with GC‐MS platform. Results: The result of alpha diversity of Shannon index showed that the difference among the two stages of BG group and HC group wasn't statistically significant, while the result of beta diversity based on the weighted UniFrac distance suggested that the structure of intestinal microbiota of BG group at YPO stage was closer to HC group. LEfSe analysis suggested that BG_YPO stage enriched genus, such as Enterocloster and Hungatella_A_128155, which improved bile acid metabolism. Compared with BG_DPR stage, BG_YPO stage and HC group enriched Faecalibacterium and Roseburia, but depleted Streptococcus, while fecal SCFA concentrations increased. Conclusion: Patients with benign gallbladder disease and chronic cholecystitis after N‐GPS treatment for over 1 year improved gut microbial community structure. With the improving bile acid metabolism, SCFA‐producing bacteria increased and pathobionts decreased, which helped the intestinal microbiota structure of BG group at YPO stage restore and close to HC group. Trial Registration: Chinese Clinical Trial Registry identifier: ChiCTR1900028267. [ABSTRACT FROM AUTHOR]

Commonly referred to as a "porcelain gallbladder (PGB)," gallbladder calcification is usually asymptomatic. It is observed that chronic inflammation of the gallbladder can occur as a result of another underlying condition, specifically gallstone disease. In the past, there was a belief that PGB had a correlation with gallbladder cancer, with an incidence rate of 30%. However, recent studies have indicated that the rate is only 5%–22%. Patients diagnosed with PGB, who are deemed to be at an elevated risk of developing cancer may undergo prophylactic cholecystectomies. However, recent research indicates that a subset of these patients may potentially avoid this surgical intervention. As a result of the increased risk of gallbladder cancer, and the difficulty of holding and retracting the gallbladder, laparoscopic cholecystectomy was not often recommended for patients with PGBs in the past. However, with the advancement of technology laparoscopy is now a choice for such difficult cases. Here we report a case of PGB in a 55-year-old female patient who complained of intermittent pain in the right upper abdomen with vaginal discharge. She was successfully managed laparoscopically. [ABSTRACT FROM AUTHOR]

Background: Gallbladder is a very common organ to be affected by many pathological processes of which gallstones and inflammatory disorders constitute the most. More than 95% of biliary tract disease is attributable to gallstones. This spectrum also includes neoplasms and tumor like conditions which are uncommon. Aim: To study the spectrum of histopathological lesions in gallbladder in cholecystectomy specimens. Materials and Methods: The study was conducted in the department of pathology at a tertiary care hospital for a period of 2 years from June 2019 to May 2021. A total of 177 specimens were studied. Results: In the present study, gallstones and related diseases were more common in women with maximum incidence in 4th and 5th decade of life. Among the two classes of gallstones, pigment stones were more common. Histopathological findings depicted that chronic cholecystitis was the most prevalent [162/177 cases] followed by acute on chronic cholecystitis [7/177 cases], acute cholecystitis [2/177 cases], empyema [1/177 cases] and cholesterolosis [1/177 cases]. Besides these, reactive atypia [1/177 cases], hyperplasia [1/177 cases] and carcinoma [2/177 cases] were present among the spectrum of diseases. Both the cases of gallbladder carcinoma occurred in male patients in this study. Conclusion: The study revealed that most of the lesions of gallbladder are inflammatory in origin due to underlying gallstones, of which the most common being chronic cholecystitis in females aged 30-40 years. The study also demonstrated that gallbladder carcinoma is a rare occurance. Novelty: In this study, gallbladder carcinoma occurred incidentally in one patient emphasizing the need for doing routine histopathological examination of all cholecystectomy specimens. [ABSTRACT FROM AUTHOR]

Introduction: Various types of metaplastic changes, such as gastric metaplasia (foveolar type or antral type) and intestinal metaplasia, are observed in chronic cholecystitis but not in normal mucosa. Helicobacter species can be detected in the bile and gallbladder tissue of patients with benign gallbladder disease. Objective: The present study aimed to observe the correlation between chronic cholecystitis and the presence of Helicobacter pylori as well as the different types of metaplastic changes in gallbladder mucosa. Materials and Methods: This descriptive, observational study was conducted at the Departments of Pathology and Surgery at a tertiary care medical college and hospital from April 2021 to March 2022, using a cross-sectional design. All confirmed cases of chronic cholecystitis, with or without cholelithiasis, were included in the study. Results: Intestinal metaplasia was the most common type of metaplastic change in the gallbladder epithelium in chronic cholecystitis in this region. PAS and Alcian Blue positivity were significantly higher in cases with metaplasia compared to those without metaplasia. H. pylori was detected in 3 cases (1.55%) of chronic cholecystitis in this study population. Conclusion: Mucin histochemistry may help identify early metaplastic changes in gallbladder epithelium. The use of a combination of methods for the detection of H. pylori in gallbladder tissue may increase the detection of positive cases.

Biliary dysbiosis is associated with gallbladder cancer (GBC). We aimed to look for biliary bacteria specifically detected in GBC patients. We used 16S rRNA-based metagenomic analysis to elucidate biliary microbiota in 30 GBC and 30 gallstones-associated chronic cholecystitis patients. Relative abundance of five genera, Streptococcus, Enterococcus, Halomonas, Escherichia and Caulobacter was significantly associated with GBC. Of 15-species, 7 were detected significantly higher in GBC, Streptococcus anginosus, Streptococcus constellatus, Streptococcus intermedius, Actinomyces bowdenii, Actinomyces israelii, Actinomyces gerencseriae, and Escherichia fergusonii were biosafety level-2 infectious bacteria; other 8 species were biosafety level-1 bacteria. These bacterial species may be involved in pathogenesis of GBC. [ABSTRACT FROM AUTHOR]

Gall Bladder can be affected by various pathologies of which gall stones and inflammatory conditions are common. Neoplasms are rare but can be fatal if diagnosed late, thus the histopathological studies of all the cholecystectomy specimen is essential. The aim of this study was to determine the histopathological spectrum of gallbladder lesions in cholecystectomy specimens and their association with age & sex of the patients. This study was done in the Department of Pathology, IIMSR in UP from May 2022 to February 2024. A total of 115 specimens were taken and their clinical details and histological findings were analysed. Out of 115 cases, gallstones and related diseases showed female preponderance 84 (73.04%), male patients were 31(26.95%). Maximum incidence was seen in 2nd & 3rd decade of life (64cases). Histopathological examination revealed Chronic cholecystitis (CC) with cholelithiasis was the most prevalent lesion (46 patients) which was followed by CC(25 cases),CC with cholestrolosis(11 cases),CC with cholestrolosis and cholelithiasis (8 cases),CC with pyloric metaplasia (5 cases),CC with reactive atypia (4 cases),CC with cholelithiasis and dysplasia (4 cases),Chronic fibrosing CC with focal reactive atypia(3cases),Acute on chronic cholecystitis with mild focal dysplasia(2 cases),Xanthogranulomatous CC(2 cases),CC with papillary hyperplasia(2 cases),CC with adenomatous hyperplasia and focal dysplasia(1 case),GB adenocarcinoma(1case),Intracystic papillary neoplasm with an associated invasive carcinoma(1 case). [ABSTRACT FROM AUTHOR]

Objective: To study the spectrum and distribution of histopathological changes and evaluate immunohistochemistry markers p53 protein and Ki67 antigen in various lesions of gall bladder. Materials and Methods: A total of 804 consecutive gall bladder specimens were evaluated. Forty cases were selected for immunohistochemical analysis to evaluate expression of p53 and ki67 proliferation index, including 20 carcinoma gall bladder cases and 20 cases of inflammatory pathology associated with metaplasia, atypia, hyperplasia, dysplasia, and adenoma. p53 immunostaining was categorized as wild type and mutant type. ki67 of >20% was considered high expression. Results: The majority of the gall bladder lesions were inflammatory in origin, most common being chronic cholecystitis. In the group of 20 gall bladder carcinoma cases, 65% were p53 mutant and the remaining 35% cases had a p53 wild-type immunophenotype. 55% cases showed high expression for ki67 labeling. However, significant correlation (P < 0.05) was seen with lympho-vascular invasion. Among non-malignant lesions, normal/wild-type p53 expression was seen with increasing intensity and positivity in lesions with atypia and intra-epithelial neoplasms. Ki67 index also showed the same trend in all cases. Conclusions: p53 and ki-67 expression increases in inflammation, and further increment occurs in premalignant and malignant lesions of the gall bladder epithelium and can be used as a marker of aggression of histopathological lesions. The results emphasize the potential of Ki-67 and p53 as biomarkers of carcinogenesis in gall bladder carcinoma.

Acupuncture, a well-established traditional medical practice in East Asia, is rarely associated with complications associated with broken needles. A 45-year-old woman had received acupuncture treatment 3 months before presentation to relieve back pain and complained of persistent epigastric pain. Radiological studies revealed chronic cholecystitis with stones and a broken acupuncture needle in the pancreatic head. Laparoscopic cholecystectomy and foreign body removal were performed, and the patient recovered quickly during a short hospital stay. We confirm that a needle found in the pancreas can usually be safely removed with minimally invasive surgery. [ABSTRACT FROM AUTHOR]

Ectopic pancreatic tissue (EPT) is a rare condition in which pancreatic tissue is situated outside its normal position. It is commonly found in the stomach and small bowel, typically asymptomatic, and is usually discovered incidentally during histopathological analysis. Although fewer than 40 cases of ectopic pancreatic tissue in the gallbladder have been reported, its significance relies on the risk of malignant transformation, highlighting the need for a thorough pathological study. This case report describes the presence of EPT in the gallbladder incidentally found during the pathological examination following a laparoscopic cholecystectomy of a 37-year-old female due to chronic cholecystitis. [ABSTRACT FROM AUTHOR]

Background. The impact of the standard balneotherapeutic complex at Truskavets' Spa on physical performance in both rats and resort patients yielded mixed results. Previous research has indicated that the phytoadaptogen "Balm Truskavets" can mitigate the negative effects of Naftussya bioactive water on dynamic muscle performance in healthy rats and patients with post-radiation encephalopathy. This study aims to evaluate the potential of this phytocomposition to prevent unfavorable actotropic effects of Truskavets' Spa balneofactors on gastroenterologic patients. Material and methods. The study observed 40 former female athletes (aged 30÷76 years, body weight 55÷98 kg) with chronic cholecystitis in remission phase, undergoing rehabilitation at Truskavets' Spa. Parameters including PWC150, adaptation hormone levels, HRV, EEG, immunity, metabolism and gas discharge visualization (GDV) were recorded. Members of the control group received for two weeks standard balneotherapy: drinking of Naftussya bioactive water, application of Ozokerite, baths with mineral water, therapeutic physical education. Members of the main group additionally received a phytoadaptogen. Results. The analysis of individual changes revealed that normal levels of PWC in control group fell to the lower zone of the norm. Phytoadaptogen prevents PWC decrease. This is accompanied by the prevention of both a decrease in power spectral density (PSD) T4-θ EEG and VLF HRV, leukocytes level as well as area and symmetry of GDV, as well as an increase in vagal tone and entropy of HRV as well as a rightward shift in the symmetry of the virtual first Chakra of GDV. In addition, phytoadaptogen reverses balneotherapy-induced moderate decrease in the frequency of a-rhythm, PSD O1-β, sympathetic tone, serum levels of catecholamines, testosterone and IgG, activity of Na,K-ATPase of erythrocyte shadows as well as Energy of the first, third and fourth virtual Chakras. Phytoadaptogen potentiates the reduction of PSD P4-β, IgM and cholesterol as well as initiates the reduction of α-rhythm variability, PSD of α-rhythm in C3, C4, P4 and Fp2 loci, entropy in F4 locus as well as serum potassium while increasing in serum cortisol and calcitonin, blood B-lymphocytes levels as well as PSD Fp2-δ. Conclusion. The phytoadaptogen "Balm Truskavets'" prevents the adverse effect of the standard balneotherapeutic complex of the Truskavets' Spa on PWC by, apparently, its neuro-endocrine effects. [ABSTRACT FROM AUTHOR]

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies 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.)

Tuberculosis (TB) is an infectious disease caused by acid-fast bacilli Mycobacterium tuberculosis (MTB). The lung remains the most common site involved by it. Extrapulmonary sites of TB are lymph nodes, pleura, bone, joints, urogenital tract, and meninges. Isolated Cystic Duct Tubercular Lymphadenitis (CDL TB) without involving the gallbladder is an uncommon manifestation of TB that primarily affects the lymph nodes around the cystic duct. A multidisciplinary approach is essential for accurate diagnosis and successful management of such cases. The authors hereby present a case of a 28-year-old female, without any evidence of TB elsewhere and an incidental finding of CDL TB. “The patient was sent with a clinical diagnosis of Chronic Calculus Cholecystitis (CCC)”. This highlights the need for comprehensive clinical evaluation and diagnostic investigations to avoid misdiagnosis or delayed management. This underscores the significance of maintaining a high index of suspicion for extrapulmonary TB, particularly in regions where the disease remains endemic. Healthcare practitioners should be vigilant when encountering unusual clinical presentations or when dealing with atypical combinations of gallbladder pathologies, as illustrated by the concurrent occurrence of CDL TB with CC with evidence of Pyloric Metaplasia (PM) and cholesterolosis without cholelithiasis, as in the patient of the present case report.

Abstract 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 Background Chronic cholecystitis, characterized by persistent inflammation of the gallbladder, predominantly stems from the prolonged presence of gallstones. Calculous cholecystitis has demonstrated a consistent escalation in its incidence over time.Gallbladder stones have been recognized as a predisposing factor for the development of biliary tract infections.Concomitantly, there have been substantial shifts in the distribution and resistance profiles of pathogenic microorganisms responsible for biliary tract infections. The timely acquisition of bile samples for pathogen analysis is of paramount importance, given its critical role in guiding judicious clinical pharmacotherapy and enhancing patient prognosis. Case Presentation We present a case involving a 66-year-old female patient who had previously undergone subtotal gastrectomy due to diffuse large B-cell lymphoma. The patient was admitted to our institution with complaints of abdominal pain. Subsequent diagnostic evaluation revealed concurrent choledocholithiasis and cholecystolithiasis. The patient underwent surgical cholecystectomy as the therapeutic approach. Histopathological examination of the excised gallbladder disclosed characteristic features indicative of chronic cholecystitis. Subsequent laboratory analysis of the patient’s bile specimen yielded Gram-positive cocci, subsequently identified through biochemical assays, mass spectrometry, and 16 S rRNA analysis as Vagococcus fluvialis. Further in vitro antimicrobial susceptibility testing using disk diffusion and microfluidic dilution showed that this strain exhibited inhibition zone diameters ranging from 12.0 to 32.0 mm in response to 26 antibiotics, including ampicillin, cefazolin, cefuroxime, cefotaxime, ceftriaxone, cefepime, ampicillin/sulbactam, piperacillin, ciprofloxacin, cefoperazone/sulbactam, imipenem, meropenem, piperacillin/tazobarb, penicillin, erythromycin, chloramphenicol, vancomycin, methotrexate/sulfamethoxazole, teicoplanin, linezolid, tigecycline, cefoxitin, ceftazidime, levofloxacin, minocycline and tobramycin. However, the inhibition zone diameters were 6.0 mm for amikacin, oxacillin, clindamycin, and tetracycline. The patient received ceftazidime anti-infective therapy both preoperatively and within 24 h postoperatively and was discharged successfully one week after surgery. Conclusion In this study, we present the inaugural isolation and identification of Vagococcus fluvialis from bile specimens of patients afflicted with calculous cholecystitis. This novel finding lays a substantial experimental groundwork for guiding clinically rational antimicrobial therapy and advancing the exploration of relevant pathogenic mechanisms pertaining to Vagococcus fluvialis infections.

Cholecystitis is a common diagnosis which requires management by general surgeons. Morbidity from cholecystitis is often life-threatening, especially in patients with underlying liver cirrhosis or other medical comorbidities. Diagnosis and management of this disease can vary among providers and hospitals. The decision to utilize a radiological or endoscopic temporizing maneuver in severe acute cholecystitis and the timing of later definitive cholecystectomy are relevant points of discussion within general surgery societies. In the last 5 years, the use of intraoperative ductal imaging by conventional vs fluorescence cholangiography had gained significant interest due to the widespread availability of indocyanine green. Finally, the operative strategies and how to manage intra-/postoperative complications are very important to optimizing patient outcomes. In this review paper, we discuss all treatment aspects of cholecystitis and provide updates in its management. [ABSTRACT FROM AUTHOR]

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]

Background: Chronic cholecystitis, characterized by persistent inflammation of the gallbladder, predominantly stems from the prolonged presence of gallstones. Calculous cholecystitis has demonstrated a consistent escalation in its incidence over time.Gallbladder stones have been recognized as a predisposing factor for the development of biliary tract infections.Concomitantly, there have been substantial shifts in the distribution and resistance profiles of pathogenic microorganisms responsible for biliary tract infections. The timely acquisition of bile samples for pathogen analysis is of paramount importance, given its critical role in guiding judicious clinical pharmacotherapy and enhancing patient prognosis. Case Presentation: We present a case involving a 66-year-old female patient who had previously undergone subtotal gastrectomy due to diffuse large B-cell lymphoma. The patient was admitted to our institution with complaints of abdominal pain. Subsequent diagnostic evaluation revealed concurrent choledocholithiasis and cholecystolithiasis. The patient underwent surgical cholecystectomy as the therapeutic approach. Histopathological examination of the excised gallbladder disclosed characteristic features indicative of chronic cholecystitis. Subsequent laboratory analysis of the patient's bile specimen yielded Gram-positive cocci, subsequently identified through biochemical assays, mass spectrometry, and 16 S rRNA analysis as Vagococcus fluvialis. Further in vitro antimicrobial susceptibility testing using disk diffusion and microfluidic dilution showed that this strain exhibited inhibition zone diameters ranging from 12.0 to 32.0 mm in response to 26 antibiotics, including ampicillin, cefazolin, cefuroxime, cefotaxime, ceftriaxone, cefepime, ampicillin/sulbactam, piperacillin, ciprofloxacin, cefoperazone/sulbactam, imipenem, meropenem, piperacillin/tazobarb, penicillin, erythromycin, chloramphenicol, vancomycin, methotrexate/sulfamethoxazole, teicoplanin, linezolid, tigecycline, cefoxitin, ceftazidime, levofloxacin, minocycline and tobramycin. However, the inhibition zone diameters were 6.0 mm for amikacin, oxacillin, clindamycin, and tetracycline. The patient received ceftazidime anti-infective therapy both preoperatively and within 24 h postoperatively and was discharged successfully one week after surgery. Conclusion: In this study, we present the inaugural isolation and identification of Vagococcus fluvialis from bile specimens of patients afflicted with calculous cholecystitis. This novel finding lays a substantial experimental groundwork for guiding clinically rational antimicrobial therapy and advancing the exploration of relevant pathogenic mechanisms pertaining to Vagococcus fluvialis infections. [ABSTRACT FROM AUTHOR]

The comorbidity of primary OA and diseases of the gastrointestinal tract, which EPI accompanies, is an extremely relevant, complex, and unstudied problem of modern medicine, as it has a number of unsolved problems both in the treatment and rehabilitation of such patients. Common pathogenetic mechanisms of the progression of such comorbidity often have a mutually aggravating effect, which requires further study. The aim of the study is to analyze the changes in indicators of exocrine pancreatic insufficiency (EPI) in patients with primary OA under the conditions of comorbidity with diseases of the gastrointestinal tract (GI). Research material and methods. 304 patients with primary OA in comorbidity with diseases of the gastrointestinal tract accompanied by non-exacerbation EPI were examined. The comparison group consisted of 30 practically healthy individuals who did not have clinical, anamnestic, and instrumental signs of diseases of the gastrointestinal tract and joints. Results and discussion. It was established that in patients with primary OA in comorbidity with diseases that are accompanied by EPI, the levels of EPI indicators were statistically significantly different depending on the etiology of EPI. Conclusion. Post hoc analysis established the ranking of the pathology of the gastrointestinal tract, accompanied by EPI, according to the indicators of EPI in primary OA, which was located as follows, starting from the highest: CP - T2DM - chronic non-calculous cholecystitis and functional diseases of the gallbladder and biliary system - chronic gastroduodenitis (p =0.05). [ABSTRACT FROM AUTHOR]

Abstract Background Fascioliasis, caused by Fasciola hepatica, is a neglected zoonotic food-borne trematodiasis. The Caspian littoral in northern Iran is endemic for the disease, and human fascioliasis is well-known in that region. In the present study, we report the diagnosis, identification, and clinical management of a human case of fascioliasis associated with common bile duct (CBD) obstruction from a non-endemic remote area in southeastern Iran. Case presentation A 42-year-old female was admitted to Afzalipour Medical Center hepatobiliary surgery ward in Kerman with abdominal pain for the past three months. Dilated biliary tract and an ill-defined mass in CBD were reported in abdominal ultrasonography and magnetic resonance cholangiopancreatography, respectively. During distal CBD operation, nine leaf-like motile flatworms were isolated. A morphological study confirmed all the isolates as Fasciola, and further molecular investigations, identified the flukes as F. hepatica using both pepck multiplex PCR and cox1 sequencing. Conclusion Molecular and morphological findings of the study indicated the presence of human fascioliasis in the southeastern province of Sistan and Baluchestan in Iran. Fascioliasis is among the etiologies of chronic cholecystitis, and physicians should consider chronic cholecystitis associated with fascioliasis in the differential diagnosis. In the present report, endoscopic ultrasound was usefully applied for the accurate diagnosis of biliary fasciolosis.

The objective of the study is to identify the effective common Chinese herbal medicines used in treating chronic cholecystitis with liver-gallbladder dampness-heat syndrome (CCLGDHS) through reviewing relevant clinical studies published in the past 10 years. Data were collected from ScienceDirect and Chinese National Knowledge Infrastructure. Data screening was carried out for the abstracts and full texts of the data. The top 15 Chinese herbal medicines with the highest occurring frequency were selected, statistically analyzed, and classified by their medicinal properties, actions, and indications according to the Chinese Pharmacopoeia 2015 edition. The top 15 effective common Chinese herbal medicines comprise Chai Hu, Huang Qin, Jin Qian Cao, Bai Shao, Yin Chen, Yu Jin, Chuan Lian Zi, Yan Hu Suo, Zhi Shi, Ban Xia, Bai Zhu, Pu Gong Ying, Gan Cao, Zhi Zi, and Qing Pi. The predominant natures were cold, cool, and warm. This combination can clear stagnant heat, warm Yang, and regulate Qi dynamics. In addition, bitter, pungent, and sweet were the predominant flavors. They can clear dampness-heat, regulate Qi dynamics to relieve cramps and pain, as well as tonify the deficiency. Along with entering the liver and gallbladder meridians, these herbal medicines also entered the spleen, stomach, and lung meridians to prevent potential disease transmission. The combinatorial medicinal actions of the effective common Chinese herbal medicine highlight the importance of the holistic concept of traditional Chinese medicine when treating CCLGDHS. In addition, the inclusion of activating blood to promote blood circulation, relieving cramps and alleviating pain, and tonifying the spleen and stomach represents a new finding in the treatment principle for CCLGDHS.

Summary. The comorbidity of primary OA and diseases of the gastrointestinal tract, which EPI accompanies, is an extremely relevant, complex, and unstudied problem of modern medicine, as it has a number of unsolved problems both in the treatment and rehabilitation of such patients. Common pathogenetic mechanisms of the progression of such comorbidity often have a mutually aggravating effect, which requires further study. The aim of the study is to analyze the changes in indicators of exocrine pancreatic insufficiency (EPI) in patients with primary OA under the conditions of comorbidity with diseases of the gastrointestinal tract (GI). Research material and methods. 304 patients with primary OA in comorbidity with diseases of the gastrointestinal tract accompanied by non-exacerbation EPI were examined. The comparison group consisted of 30 practically healthy individuals who did not have clinical, anamnestic, and instrumental signs of diseases of the gastrointestinal tract and joints. Results and discussion. It was established that in patients with primary OA in comorbidity with diseases that are accompanied by EPI, the levels of EPI indicators were statistically significantly different depending on the etiology of EPI. Conclusion. Post hoc analysis established the ranking of the pathology of the gastrointestinal tract, accompanied by EPI, according to the indicators of EPI in primary OA, which was located as follows, starting from the highest: CP ˃ T2DM ˃ chronic non-calculous cholecystitis and functional diseases of the gallbladder and biliary system ˃ chronic gastroduodenitis (p ˂0.05).

Bilioenteric fistulae are rare and difficult to manage complications of chronic cholecystitis. While cholecystoduodenal and cholecystocolic fistulae are more common, a cholecystoappendiceal fistula is an extremely rare finding. We report the presentation and operative management of a 59-year-old male with cholecystoappendiceal fistula and associated abscess in the gallbladder fossa. The patient was appropriately resuscitated, the abscess drained by interventional radiology, and after a complete workup, underwent a laparoscopic appendectomy and cholecystectomy. Pathology revealed moderately differentiated appendiceal adenocarcinoma requiring a right hemicolectomy with cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC). He has recovered well postoperatively with no complications. This case highlights the importance of having a very high index of suspicion for underlying malignancy when managing a fistula of any kind. To the best of our understanding, this is only the second reported case of a cholecystoappendiceal fistula. [ABSTRACT FROM AUTHOR]

Background : Surgeons can minimize the risk of bile duct injury (BDI) during challenging mini-invasive cholecystectomy through technical standardization by means of a precise anatomical landmark identification (Critical View of Safety) and advanced technology for biliary visualization. Among these systems, the adoption of magnified stereoscopic 3-dimensional view provided by robotic platforms and near infrared fluorescent cholangiography (NIRF-C) is the most promising. Methods: In this prospective cohort study, we evaluated all consecutive minimally invasive cholecystectomies (laparoscopic and robotic) performed with NIRF-C between May 2022 and January 2023 at General Surgery Unit, Department of Health Sciences, University of Milan, San Paolo Hospital (Milan, Italy). Inclusions criteria were as follows: (1) acute cholecystitis (emergency group), (2) history of chronic cholecystitis or complicated cholelithiasis (deferred urgent group), (3) difficult cases (patients affected by cirrhosis, with scleroatrophic gallbladder or BMI > 35 kg/m2). For each group, the detection rate and visualization order of the main biliary structures were reported (cystic duct, CD; common hepatic duct, CHD; common bile duct, CBD; and CD-CHD junction). Results: A total of 101 consecutive patients were enrolled, including 83 laparoscopic and 18 robotic cholecystectomies. All patients were stratified into three subgroups: (a) emergency group (n = 33, 32.7%), (b) deferred urgent group (n = 46, 45.5%), (c) difficult group (n = 22, 21.8%). Visualization of at least one biliary structure was possible in 94.1% of cases (95/101). Interestingly, all four main structures were detected in 43.6% of cases (44/101). The CD was the structure identified most frequently, being recognized in 91/101 patients (90.1%), followed by CBD (83.2%), CHD (62.4%), and CD-CHD junction (52.5%). In the subset of patients that underwent emergency surgery for AC, the CD-CHD confluence was identified in only 45.5% of cases. However, early and precise identification of CBD (75.8%) and CD (87.9%) allowed safe isolation, clipping, and transection of the cystic duct. In the deferred urgent group, the CBD and the CD were easily identified as first structure in a high percentage of cases (65.2% and 41.3% respectively), whereas the CD-CHD junction was the third structure to be identified in 67.4% of cases, the highest value among the three subgroups. In the difficult group, NIRF-C did not prove to be a useful tool for biliary visualization. The rates of failure of visualization were elevated: CBD (27.3%), CD (18.2%), CHD (54.5%), and CD-CHD (68.2%). Conclusions: NIRF-C is a powerful real-time diagnostic tool to detect CBD and CD during minimally invasive cholecystectomy, especially when inflammation due to acute or chronic cholecystitis subverted the anatomy of the hepatoduodenal ligament. [ABSTRACT FROM AUTHOR]

Background: This study embarked on a critical analysis of the morphological and biochemical characteristics of the gall bladder in individuals diagnosed with gallstones, aiming to extend the understanding of gallstone pathogenesis. Methods: A prospective study was conducted at the Dr. B. S. Kushwah Institute of Medical Sciences, where participants were recruited to undergo detailed analyses, including histopathological examinations, biochemical analysis of bile, microbial analysis, and imaging analysis. Results: The study identified a significant presence of cholesterol gallstones (70%) in the population, with a high incidence of gallbladder inflammation (75%) and chronic cholecystitis (70%). The biochemical analysis revealed elevated levels of cholesterol (mean 5.2 mmol/L) and bilirubin (mean 17.3 μmol/L) in the bile. Furthermore, a notable presence of Firmicutes (90%) and Bacteroidetes (75%) was observed in the microbial analysis, indicating a potential correlation with gallstone formation. Conclusion: Our study underscores the chronic nature of gallstone disease, highlighting the role of bile composition and microbiota diversity in its pathogenesis. The findings present avenues for future research, potentially focusing on preventive strategies based on bile composition alterations and microbial diversity. [ABSTRACT FROM AUTHOR]

Hyalinizing cholecystitis is a rare subtype of chronic cholecystitis in which the gallbladder tissue is replaced with hyaline sclerosis, more or less, and has a characteristic intraoperative appearance. Preoperative diagnosis is hard to establish. The entity is strongly associated with gallbladder carcinoma. Therefore, the pathologist should perform a thorough microscopic analysis. We present a case of an unusual intraoperative finding in a male patient with chronic cholecystitis which was proved to be a hyalinizing cholecystitis. [ABSTRACT FROM AUTHOR]

Background: Fascioliasis, caused by Fasciola hepatica, is a neglected zoonotic food-borne trematodiasis. The Caspian littoral in northern Iran is endemic for the disease, and human fascioliasis is well-known in that region. In the present study, we report the diagnosis, identification, and clinical management of a human case of fascioliasis associated with common bile duct (CBD) obstruction from a non-endemic remote area in southeastern Iran. Case presentation: A 42-year-old female was admitted to Afzalipour Medical Center hepatobiliary surgery ward in Kerman with abdominal pain for the past three months. Dilated biliary tract and an ill-defined mass in CBD were reported in abdominal ultrasonography and magnetic resonance cholangiopancreatography, respectively. During distal CBD operation, nine leaf-like motile flatworms were isolated. A morphological study confirmed all the isolates as Fasciola, and further molecular investigations, identified the flukes as F. hepatica using both pepck multiplex PCR and cox1 sequencing. Conclusion: Molecular and morphological findings of the study indicated the presence of human fascioliasis in the southeastern province of Sistan and Baluchestan in Iran. Fascioliasis is among the etiologies of chronic cholecystitis, and physicians should consider chronic cholecystitis associated with fascioliasis in the differential diagnosis. In the present report, endoscopic ultrasound was usefully applied for the accurate diagnosis of biliary fasciolosis. [ABSTRACT FROM AUTHOR]

Canine gallbladder related diseases are being reported with an increased frequency by specialists working in small animal veterinary medicine. It is presumed that these represent a direct consequence following changes in diet, lifestyle and activity levels of small animals. As a result of increased assertion towards the well-being of pets worldwide, veterinary medicine has evolved by creating and implementing new diagnostic protocols and noninvasive means of investigations, like ultrasonography, which can characterize the presence and intensity of any abnormalities encountered in the canine gallbladder. [ABSTRACT FROM AUTHOR]

This study has aim to reduce the risk of postoperative complications of surgical treatment of patients with acute cholecystitis on the base of alaboration of optimal tactics of laparoscopic cholecystectomy. This study has been performed on the base of research results of 162 patients with acute cholecystitis who had laparoscopic cholecystectomy finished with conversion cholecystectomy. Clinical experience of using traditional and conversion laparoscopic surgery in patients with acute and chronic cholecystitis, with cholelithiasis has been integrated on this material, and also comparative assessment of this methods performed. The analysis of the causes of conversion of the laparoscopic cholecystectomy to traditional cholecystectomy done, and also estimate of probability of such conversion has been implemented. Complex of organizational-methodical and tactical-technical prevention measures of intra- and postoperative complications of traditional and conversion Endosurgery has been worked out and introduced by authors. [ABSTRACT FROM AUTHOR]

Background: There are certain differences between early and late feeding. The purpose of this study was to investigate how early eating influenced the emergence and persistence of paralytic ileus following gastrointestinal surgery. to research how early enteral feeding after digestive tract surgery affects anastomotic leak. To find out how early enteral feeding impacts wound infection is the goal of this investigation. the effect of tolerance on early enteral feeding should be examined. Material and Methods: Between August 2021 to July 2022, the trial included 100 patients with a range of conditions. After that, they had the option of having a late or early meal. The chi square test, Fischer's exact test, and the student "t" test were all used for statistical comparison. Results: The early feeding group consisted of 50 patients, while the late feeding group included 50 individuals. There are no statistically notable variations between the two groups. A 17-day average hospital stay and a 4-hour average operation time were found in the group with the same age distribution (45.26+14.89 versus 46.06+15.86, 1) = 0.798). 10.2% of late-feeding patients and 6.1% of early-feeding patients both experienced paralytic ileus, with 72% of these cases requiring the use of EA+GA (P=0.657). Patients who eat later develop astomotic leaks at a rate of 2.0% as opposed to 0% of patients who eat earlier (p=1). 14.3% of late feeders and 10.2% of early feeders had wound infections (p=0.317), whereas 12.2% of late feeders and 16.3% of early feeders had oral feeding intolerance. Conclusion: A shorter hospital stay was associated with early feeding, but late feeding was associated with the same level of paralytic ileus. Wound infection was less likely following an early meal than following a late feeding. With late feeding, anastomotic leak probability increased. With later meals, the patients' ability to tolerate oral feeding improved. There were no beneficial effects in this trial from either early or delayed enteral feeding. [ABSTRACT FROM AUTHOR]

Competing Interests: None

Background: Chronic cholecystitis (CC) accounts for more than 90% of cholecystectomies. Some recent work has demonstrated the presence of Helicobacter pylori in bile and the gallbladder of more than three-fourths of the patients with gallbladder carcinoma (GBC) and in more than half of the patients with CC. Objective: To study the histopathological findings and to demonstrate the presence of H. pylori in CC and GBC in our region. Materials and Methods: One hundred fifty cholecystectomy specimens received during two years were examined after obtaining ethical clearance for the study. The specimens were received in 10% neutral buffered formalin. The specimens were processed, paraffin-embedded, and stained with Hematoxylin and Eosinand Giemsa stain, for the detection of H. pylori. Immunohistochemistry (IHC) for H. pylori was done on 35 cases. Results: Of the 150 cases of cholecystectomy specimens, the majority of the patients were in the age group of 41–50 years, with the male:female (M:F) ratio being 1:1.9. The most common lesion was chronic calculous cholecystitis (76%). The spectrum of lesions in our study included chronic acalculouscholecystitis (1.3%), follicular cholecystitis (4.6%), xanthogranulomatous cholecystitis (3.3%), acute over CC (2.6%), eosinophilic cholecystitis (2%), cholesterolosis (2%), choledochal cyst (1.3%), acute calculous cholecystitis (1.3%), empyema (0.66%), and gallbladder carcinoma (GBC; 3.3%). Giemsa stain on 150 cases was negative for H. pylori. On 35 cases an IHC was done; none detected H. pylori, indicating that H. pylori infection does not contribute to the development of gallstones in this region.

Background: Cholecystitis is one of the most common infections treated surgically in the United States. Surgical risk is prohibitive in some patients, leading to alternative therapeutic strategies, including medical management (antibiotics) with or without percutaneous cholecystostomy tube (PCT) drainage.Materials and Methods: Using the Healthcare Cost and Utilization Project (HCUP) National Readmission Database (NRD), we performed a retrospective review to compare medically managed patients with or without PCT placement by evaluating 60-day readmissions rates, health care costs, and hospital length of stay (LOS). Both study groups were matched using the Elixhauser comorbidity index, age, and sex. Univariate and multivariate statistical analyses were performed using STATA.Results: 776,766 patients were included in the analysis. The population receiving PCT placement was on average 16 years older (69.9 vs 53.6 years; P < .01), less likely to be female (40.7% vs 59.3%; P < .01), and had almost twice as many comorbidities (3.36 vs 1.81; P < .01) compared to the population receiving medical management. After matching our data to account for these incongruities, PCT patients were still 10.4 times more likely to be readmitted, had a 11.6% increase in the cost of care, and a 37.6% increase in LOS compared to those managed medically.Discussion: Percutaneous cholecystostomy tube placement for cholecystitis is associated with a higher readmission rate, increased charges, and increased LOS compared to antibiotic therapy alone, even after correcting for age, sex, and comorbidities. [ABSTRACT FROM AUTHOR]

Introduction: Fibrosis caused by chronic inflammation in the gallbladder increases the risk of biliary tract injury. Our aim was to investigate a possible correlation between pre-operative routine examinations and the degree of chronic inflammation. Materials and Methods: Samples from 74 patients with chronic cholecystitis (CC) were reevaluated to determine the degree of chronic inflammation. The relationship of gallbladder wall thickness and gallbladder stone size in pre-operative abdominal ultrasonography (USG), pre-operative laboratory values, and endoscopic retrograde cholangiopancreatography (ERCP) history with the degree of histopathological chronic inflammation in the gallbladder wall was evaluated. In addition, adhesion of the surrounding tissues to the gallbladder, operation time, hospitalization period, biliary tract injury, and post-operative complications were examined in the context of degree of chronic inflammation. Results: Grade I CC was detected in 53 (69.8%) and Grade II in 21 (27.6%) patients. While the gallbladder wall was thick (>3 mm) on pre-operative USG in 7 (33.3%) patients with Grade II CC, it was normal in all patients with Grade I (p<0.001). A history of pre-operative ERCP was found in 2 (3.8%) patients in Grade I CC and in 7 (33.7%) patients in Grade II (p=0.002). In univariate and multivariate analysis, gallbladder wall thickness and history of ERCP were found to be significant in predicting the degree of chronic inflammation [(p<0.001 and p=0.002), (p=0.003 and p=0.014), respectively]. In multivariate analysis, an increase in AST value of 1 U/L increases the probability of CC grade II by 1.1 times compared to CC grade I (p=0.019). Conclusion: Increased gallbladder wall thickness, history of ERCP, and elevated AST value in CC increase the possibility of a high degree of chronic inflammation (fibrosis rate). [ABSTRACT FROM AUTHOR]

Herbal preparations are widely used in the complementary treatment of inflammatory diseases including hepatobiliary disorders, among which chronic cholecystitis is one of the most common. This study was aimed to investigate the effect of the water extract from polyherbal composition consisting of eight medicinal plants (Helichrysum arenarium, Mentha piperita, Calendula officinalis, Taraxacum officinale, Polygonum aviculare, Matricaria chamomilla, Portulaca oleracea, Hypericum perforatum) on biochemical and haematologic indices as well as on immune reactivity parameters in patients with chronic cholecystitis. It was found that consumption of polyherbal tea during 45 days was followed by normalization of liver biochemical indices (serum level of cholesterol, alanine aminotransferase and aspartate aminotransferase activity, total and unconjugated bilirubin levels and diminution of hematological (leukocytosis, increased erythrocyte sedimentation rate and neutrophil-to-lymphocyte ratio) and immunological (increased serum level of pro-inflammatory cytokines) signs of systemic inflammation in patients with hepatobiliary disorder. The results of the research showed that the studied polygerbal composition can be recommended as a component of the complementary therapy for patients with chronic cholecystitis.

Porcelain gallbladder is a rare condition characterized by an extensive calcification of the gallbladder wall. It is associated with an increased risk of gallbladder cancer and elevated levels of tumor marker CA19-9, which is typically seen in pancreatic and biliary cancers. We present a case of a 60-year-old woman who presented with upper abdominal pain and nausea. Imaging revealed both a porcelain gallbladder and common bile duct stones. Initially, the patient underwent endoscopic retrograde cholangiopancreatography (ERCP) for the removal of the common bile duct stones. Notably, following the removal of the stones, the patient's CA19-9 levels were significantly elevated, reaching 6076 U/mL. Subsequently, she underwent a laparoscopic cholecystectomy. Histopathological examination and immunostaining for CA19-9 were performed on the resected specimen. Histopathology revealed marked fibrosis, calcification, and xanthogranulomatous inflammation of the gallbladder wall without evidence of malignancy. Immunostaining showed strong CA19-9 positivity in the inflamed gallbladder mucosal epithelium. Postoperatively, the patient's CA19-9 levels returned to normal (17 U/mL). This case highlights that a benign porcelain gallbladder can present with abnormally high CA19-9 levels, potentially mimicking malignancy. Reports of CA19-9 elevation in porcelain gallbladder are limited, and in most cases, significant CA19-9 elevation has been associated with malignancy. This case also demonstrates that benign conditions such as biliary obstruction, chronic inflammation, and xanthogranulomatous cholecystitis can cause significant elevations in CA19-9 levels. Therefore, careful differentiation and comprehensive evaluation are crucial for accurate diagnosis and appropriate management in such cases., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kidogawa et al.)

Xanthogranolumatous cholecystitis (fibroxantogranulomatous inflammation of the gallbladder) was first described in 1970. The incidence is low, between 0.7% to 10%, and more common in the 6th and 7th decade of life. Occurs when a chronic inflammation of the gallbladder by stones contribute the formation of xantogranulomatous nodules. The image features can mimic gallbladder carcinoma, there is the importance about differentiate them. we presented a case of our hospital in which the preoperatory diagnosis was gallbladder carcinoma. [ABSTRACT FROM AUTHOR]

Objectives: The main objective was to evaluate the outcome of laparoscopic cholecystectomy in terms of intra-operative complications and the rate and reasons of conversion to open cholecystectomy. Study Design: Descriptive Study. Setting: Hayatabad Medical Complex, Peshawar. Period: June 2018 to May 2019. Material & Methods: After taking consent of Hospital ethical & research committee, patients admitted with clinical diagnosis of cholelithiasis and chronic cholecystitis, confirmed by abdominal ultrasound, undergoing laparoscopic cholecystectomy fulfilling inclusion criteria were selected. Results: A total of 150 were included in the study. Mean age was 39.2yrs with female to male ratio of 9.75:1. Laparoscopic cholecystectomy was successfully accomplished in 98% cases. In 2% (3 patients) converted cases the most common cause of conversion observed was dense adhesions in the calots triangle. Intra-operative complications were noted in 1.4% patients, those included bile duct injury and leakage from the gallbladder bed. However other complications such as bowel injury, blood vessel injury, and post operative hemorrhage did not occur. Overall morbidity was 1.4% with no mortality. Conclusion: Laparoscopic cholecystectomy is a safe and effective procedure in our setup to the accepted standards, as evident by the national and international studies. And it can be accomplished with minimal morbidity and low rate of conversion with the increasing surgeon's experience. [ABSTRACT FROM AUTHOR]

Heterotopia is mass of tissue normal to the site in abnormal location. Heterotopic gastric mucosa has been described in almost every part of the gastrointestinal tract including the tongue, oesophagus, epiglottis, small bowel, appendix vermiformis, rectum and gallbladder. The diagnosis of heterotopic gastric mucosa in gallbladder can be difficult clinically. Heterotopic gastric mucosa in gallbladder can be symptomatic or detected incidentally. It is relevant to distinguish heterotopic gastric mucosa from benign polyps, gallbladder carcinoma or metastasis. We present a case of a 51 year old female patient who represented suspicious lesion on computed tomography (CT). After cholecystectomy, in the microscopical examination gastric mucosa consisting of fundic glands and pyloric glands and typical features of chronic cholecystitis are seen. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate angle-corrected peak systolic cystic artery velocity (CAv) as a predictor of acute cholecystitis among patients presenting to the emergency department (ED) with right upper quadrant (RUQ) pain. Methods: In this IRB-approved and retrospective study, CAv was evaluated in 73 patients, 43 who underwent definitive treatment with cholecystectomy or percutaneous cholecystostomy and 30 control patients without clinical suspicion for cholecystitis. In addition to CAv, the following were reviewed by 3 radiologists: CBD diameter, cholelithiasis, impacted stone in the neck, sludge, gallbladder wall thickness > 3 mm, gallbladder transverse dimension ≥ 4 cm, longitudinal dimension ≥ 8 cm, tensile gallbladder fundus sign, pericholecystic fluid, pericholecystic echogenic fat, and sonographic Murphy sign. Results: Of the 43 patients who underwent definitive treatment, 25 had acute cholecystitis (34%) and 18 (25%) had chronic cholecystitis. Average CAv measurements were 50 ± 16 cm/s (acute), 28 ± 8 cm/s (chronic), and 22 ± 8 cm/s (control; p < 0.0001). In univariate analysis, among patients who underwent definitive therapy, CAv ≥ 40 cm/s, gallbladder wall thickness, stone impaction, GB long dimension ≥ 8 cm, and elevated WBC were associated with acute cholecystitis (p < 0.05). In multivariate analysis, CAv ≥ 40 cm/s was the only statistically significant variable (p = 0.016). CAv ≥ 40 cm/s alone had a PPV of 94.7% and overall accuracy of 81.4% in diagnosing acute cholecystitis. Conclusion: CAv ≥ 40 cm/s is highly associated with acute cholecystitis in patients presenting to the ED with RUQ pain. [ABSTRACT FROM AUTHOR]

Xanthogranulomatous Cholecystitis (XGC) is a rare inflammatory condition characterized by the presence of xanthogranulomas within the gallbladder wall, often mimicking gallbladder carcinoma (GBC). Diagnosis is challenging and may require biopsy. Once GBC is excluded, an open cholecystectomy is recommended, although laparoscopic cholecystectomy is increasingly being performed with great caution. This case report aims to evaluate clinical and radiological features, surgical outcomes, and treatment approaches for XGC. A 70-year-old patient presented with right hypochondrial pain and a palpable gallbladder. A CT scan revealed a distended lithiasic gallbladder with a thickened irregular wall and hepatic nodules. A hepatic MRI suggested xanthogranulomatous cholecystitis. A CT-guided biopsy of the liver nodule showed no signs of malignancy. An open cholecystectomy with a trans-cystic drain was performed. Histological examination confirmed chronic xanthogranulomatous cholecystitis. The patient was discharged on postoperative day 10. A clinical and radiological follow-up at 6 months postoperatively showed no abnormalities. XGC presents diagnostic challenges due to its resemblance to GBC. Imaging aids in diagnosis, but biopsy may be necessary. Open cholecystectomy is the recommended surgical treatment due to excessive local inflammation and the risk of concomitant malignancy. Managing XGC demands a holistic approach that integrates all clinical insights and mandates close collaboration among a multidisciplinary team of surgeons, radiologists, and pathologists. Further research is needed to refine diagnostic and therapeutic strategies for this rare condition, especially in geriatric patients. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To compare the outcome of laparoscopic total extra peritoneal (TEP) repair versus Lichtenstein repair (LR) of inguinal hernia in terms of post-operative pain, hematoma, seroma, wound infection and early recurrence. METHODOLOGY: This randomized control trial was conducted at Surgical Unit III, General Hospital Lahore, Pakistan during the period June 2017 to May 2018. Male patients aged up to 50 years diagnosed with unilateral, reducible primary inguinal hernia were randomized into two groups, Group A (TEP) and Group B (LR), with 38 patients each. Data was collected prospectively on structured proforma. Patients were regularly followed up for one year for early postoperative complications. Statistical analysis was done using SPSS version 26. RESULTS: Out of 76 patients, mean age for TEP was 36.72±4.50 years and LR was 34.42±6.8 years. No significant difference was found in both the groups in terms of short-term postoperative complications. LR group had comparatively high rate of postoperative complications; hematoma formation (n=3/38; 7.9%), wound infection (n=3/38; 7.9%) and seroma formation (n=1/38; 2.6%). Postoperative pain with Visual Analogue Score in TEP group on the 1st day, 3rd day, 7th day and 1 month follow up was less as compared to LR group. CONCLUSION: The present study concludes that TEP is better than LR in inguinal hernia in terms of less postoperative pain after 1 month. However, no statistical difference was found in seroma and hematoma formation and wound infection.

OBJECTIVES: The aim of this study was to establish true histopathology proven diagnosis of chronic cholecystitis. METHODOLOGY: A cross-sectional study was conducted on 51 post-surgical gallbladders was done to assess their histopathological patterns in a single centered tertiary care hospital. The specimens were studied for chronic cholecystitis, fibrosis, hypertrophy and presence of Rokitansky-Aschoff sinuses. Descriptive analysis was done and associations of the histopathological changes with demographic data of patients were analyzed through Chi-squared test. RESULTS: Fifty-one post cholecystectomy samples of gallbladder were analyzed for histopathological changes with 82.4% showing chronic cholecystitis, 84.3% fibrosis, 64.7% congestion, and more than 60% mild or moderate hypertrophy. Moreover, 49% of the specimens showed Rokitansky-Aschoff sinuses. All these changes suggest chronic inflammation. CONCLUSION: Chronic cholecystitis, fibrosis, and Rokitansky-Aschoff sinuses are the most common histopathological findings in specimens of patients undergone cholecystectomy for cholelithiasis.

Introduction: In China, patients with chronic cholecystitis account for approximately 10% of the total population, in which over 90% of cholecystitis is caused by cholelithiasis. This study aimed to discuss the possible mechanism of electroacupuncture on the Yanglingquan acupoint promoting gallbladder contractibility of patients with chronic cholecystitis. Methods: 60 patients were randomly divided into a trial group and a control group. Doppler ultrasound and color Doppler blood flow imaging was applied. The trial group adopted the BT701-1B electroanesthesia apparatus to perform electroacupuncture on the bilateral acupoints of Yanglingquan, while electroacupuncture was made on sham acupoints in the control group. Results: Before the electroacupuncture, gallbladder volume was 49.6 ± 5.66 ml, after 15 min and 30 min of electroacupuncture, the gallbladder volume was then 32.9 ± 5.66 ml and 23.0 ± 2.83 ml respectively. The comparison before and after electroacupuncture was obviously and statistically different (P < 0.01). The comparison between after 15 min and 30 min is obviously statistically different (P < 0.01). Before the electroacupuncture, the gallbladder artery Vmax, Vmin, and RI were 18.4 ± 2.69 cm/s, 9.7 ± 0.07 cm/s, and 0.47 ± 0.06, respectively; the cystic artery Vmax, Vmin, and RI after 30 min were 8.1 ± 0.92 cm/s, 3.1 ± 0.57 cm/s, and 0.61 ± 0.02. The comparison in gallbladder artery Vmax and Vmin and the drag index (RI) before and after electroacupuncture was obviously and statistically different (P < 0.01). Conclusions: Electroacupuncture on the acupoints of Yanglingquan has the potential to promote the emptying of the gallbladder. The mechanism may be related to that the smooth muscle of the gallbladder contracts after electroacupuncture and the gallbladder empties. [ABSTRACT FROM AUTHOR]