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Query: UMLS:C0001511 (Adhesion)
 5,955 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The results of laparoscopic cholecystectomy in 58 of the 66 hospitals in which surgeons introduced this method after attending a practical course are evaluated. Data of 546 patients were collected. The indication for laparoscopic surgery was symptomatic gallstone disease without evidence of common bile duct stones, cholecystitis or previous upper abdominal surgery. In 70% of the 58 hospitals fewer than 10 laparoscopic cholecystectomies were performed nine months after the first practical course because of shortage of equipment. The mean age was 50 years (range 20-80) with a male:female ratio of 1:4. The average operation time was 95 minutes. In 8.2% of the patients the laparoscopic procedure was converted to laparotomy. Adhesions, cholecystitis or difficulty in recognition of the anatomy was responsible for the conversion in 31 of the 45 patients. In the remaining 14 patients bleeding or bile leakage during the procedure compelled the surgeon to perform a laparotomy. One patient died because of bleeding from the cystic artery. Eleven patients underwent laparotomy postoperatively because of bleeding (3), bile leakage (6) and lesion of the ductus choledochus (2). Minor complications occurred in 30 patients. Laparoscopic cholecystectomy is expanding rapidly in the Netherlands. The early results are encouraging, although the experience is limited. Further registration is necessary to be able to compare the results of laparoscopic cholecystectomy more critically with those of conventional cholecystectomy.
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PMID:[Laparoscopic cholecystectomy in The Netherlands: early national results]. 153 94

Adhesions formed between the gallbladder and abdominal wall secondary to gallstones and cholecystitis may result in perforation through the abdominal wall. Three cases of such cholecystocutaneous fistulae are presented and the clinical, radiographic and sonographic findings of this unusual entity are reviewed.
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PMID:Imaging in the diagnosis of cholecystocutaneous fistulae. 622 Oct 18

The effect of bile and gallstones on the peritoneal cavity was evaluated in an experimental animal study. Ninety male Sprague-Dawley rats were randomly allocated to one of six groups (n = 15). Groups 1 to 3 received an intraperitoneal injection (2 mL) of saline, sterile bile, and infected bile, respectively. Groups 4 to 6 underwent a lower midline abdominal incision (3 to 5 mm). In groups 4 and 5, a single gallstone (< 3 mm diameter) was placed in the right upper quadrant and, after closure of the wound, the animals were injected with sterile bile and infected bile, respectively. Group 6 animals underwent laparotomy alone, followed by injection of sterile saline (2 mm). All animals were killed at 4 weeks and the peritoneal cavity was carefully examined. No intra-abdominal lesions were noted in groups 1 to 3. Adhesions were noted in 11 (73%) and 10 (67%) animals of groups 4 and 5, respectively. Two intra-abdominal abscesses were noted in group 4 animals. No intra-abdominal lesions were noted in any group 6 animals. This study suggests that bile in combination with gallstones in the peritoneal cavity is associated with an increased risk of intra-abdominal adhesion formation and possible abscess formation, and that every attempt should be made to retrieve stones lost during cholecystectomy.
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PMID:The need to retrieve the dropped stone during laparoscopic cholecystectomy. 769 67

Gallstone ileus is a rare (1%-4%) complication of gallstone disease. Gallstones entering the gastrointestinal tract by penetration may cause obstruction at any point along their course through the tract; however, they have a predilection to obstruct the smaller-caliber lumen of the small intestine (80.1%) or stomach (14.2%). The condition is seen more commonly in the elderly who often have significant co-morbidities. Gallstone ileus causing large bowel obstruction is rare. We report the case of a 95-year-old woman who presented with a history of abdominal pain without fever, nausea, vomiting, or diarrhea. Computed tomography of the abdomen and pelvis with oral contrast revealed a high-density structure within the lumen of the distal sigmoid colon, initially suspected to be a foreign body. Medical management failed and surgical intervention was not possible. Autopsy revealed peritonitis and a rupture of the sigmoid colon at the site of a cylindrical stone found impacted in an area of fibrotic narrowing with multiple diverticula. A necrotic, thick-walled gallbladder had an irregular stone in its lumen that was a fracture match with the stone in the sigmoid. Adhesions, but no discrete fistula, were identified between the gallbladder and the adjacent transverse colon. The immediate cause of death was peritonitis caused by colonic perforation by the gallstone impacted at an area of diverticular narrowing. To our knowledge, such autopsy findings have not been previously reported.
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PMID:Sigmoid gallstone ileus: a challenging diagnosis. 3152 25