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Query: UMLS:C0008325 (cholecystitis)
 3,686 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To assess the role of the general surgeon in the care of patients with acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC) the hospital records of all patients with AIDS or ARC who underwent a major operation at the General Surgical Service of Crawford W. Long Memorial Hospital were reviewed. Of 79 patients with AIDS or ARC diagnosed since 1982, 14 required major abdominal surgery. Operations performed were for gastrointestinal (GI) complications of opportunistic infections and neoplasms (four), diagnosis of major retroperitoneal lymphadenopathy (four), and treatment of AIDS-related immune thrombocytopenia (six). GI complications consisted of two cases of cytomegalovirus perforation of ileum and colon, one case of bleeding ileocolonic lymphoma, and one case of cryptosporidium cholecystitis. Laparotomy for diagnosis of retroperitoneal lymphadenopathy was performed in four patients and provided diagnostic material in three of them. Six patients underwent splenectomy for AIDS-related immune thrombocytopenia. Four of these patients had previously been treated with prednisone without impressive results. All patients had marked improvement of their platelet counts and clinical bleeding after splenectomy. Postoperative complications were common and consisted of wound infection, disseminated intravascular coagulation, GI bleeding, pneumocystis pneumonia, small-bowel obstruction, and cytomegalovirus pneumonia. One patient died after laparotomy for perforated ulcers of the ileum and colon.
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PMID:Surgical complications of human immunodeficiency virus infection. 333 82

An easy, safe, and definitive operation for the "difficult gallbladder" is described and has been termed subtotal cholecystectomy. Eighteen patients underwent subtotal cholecystectomy during a 30-month period, which constitutes approximately 7% of cholecystectomies performed at our institution. The indications were cholecystitis with severe fibrosis or inflammatory changes that prevented safe dissection in Calot's triangle in 11 patients and portal hypertension in seven patients (liver cirrhosis [two patients] and segmental portal hypertension caused by chronic pancreatitis [five patients]) to prevent massive blood loss from the gallbladder bed. The operation entails leaving the posterior wall of the gallbladder attached to the liver and securing the cystic duct at its origin from within the gallbladder with a purse string technique. The latter obviates the need for dangerous dissection in Calot's triangle. Control of bleeding from the remaining gallbladder edge is greatly facilitated by the use of a running suture after each stage of piecemeal excision of the gallbladder. All patients survived the operation and wound infection occurred in only two patients (11%). One patient required a laparotomy 1 month after surgery for adhesive small bowel obstruction related to the remaining gallbladder wall and site of a liver biopsy. No patients have so far developed postcholecystectomy symptoms (median follow-up 12.2 months; range 3 to 31 months). Subtotal cholecystectomy is a definitive operation that prevents recurrent gallstone formation, as no residual diseased gallbladder mucosa is left in continuity with the biliary system. It provides a simple, safe option in patients in whom cholecystectomy could be hazardous.
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PMID:Subtotal cholecystectomy: for the difficult gallbladder in portal hypertension and cholecystitis. 389 43

In many respects abdominal pain in pregnancy is managed just as in a nonpregnant patient, but the diagnostic criteria, methods of diagnosis, therapy, and consequences of mismanagement differ. This article discusses appendicitis, cholecystitis, urolithiasis, pancreatitis, and intestinal obstruction--conditions that often manifest a similar clinical picture. The article presents epidemiologic data, distinguishing characteristics, modifications of the workup, and treatment appropriate to pregnancy and perinatal complications of each condition.
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PMID:Abdominal pain in pregnancy. 395 84

326 patients presenting with acute abdominal pain to a hospital in Tampere were compared with others in England and Norway, and with a large series of 6097 cases collected under the auspices of the World Organization of Gastro-Enterology. The distribution of disease in these 326 Finnish patients bore remarkable similarities to the distribution in other countries. When subjected to a computer-aided diagnostic analysis, comparing Finnish patients with UK and world-wide data, as regards appendicitis, cholecystitis and nonspecific pain, the computer performed roughly as well as the clinicians diagnosing the same cases. It is concluded that these diseases therefore have a common presentation in Finland with that elsewhere. As regards small bowel obstruction however, the computer diagnosed only 22% of cases correctly, (compared with the accuracy of clinical diagnosis 73%). This leads us to conclude that this disease presents unusually in Scandinavia, and possible reasons are discussed.
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PMID:Presentation and diagnosis of acute abdominal pain in Finland: a computer aided study. 636 50

The etiology of gallbladder disease in children is multifactoral. Seven of these factors are fairly well known: obstruction of biliary ductal system, hemolytic disease, estrogen effect, obesity, familial, metabolic, and stress related. Our biggest group of patients, 19 out of the total 61 or 31 per cent, were found to have had prior abdominal/renal surgery or partial bowel obstruction. It has been shown that ileal resections result in gallstones due to loss of bile salt absorption; however, volvulus and partial obstruction from adhesive bands have never been incriminated before. A number of teenagers appear to develop acalculous cholecystitis and have symptoms a good many months before stones develop. These patients who have delayed (greater than 36 hours) excretion of oral cholecystogram dye also have positive duodenal drainage studies after cholecystokinin. Gallbladder disease in children is not a rarity as surgical textbooks would lead one to believe.
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PMID:A new look at the multifactoral etiology of gallbladder disease in children. 685 71

Unruptured amoebic liver abscess is usually not regarded as a surgical emergency. At University College Hospital, Ibadan, in a two-year period from June 1975 to May 1977, six cases of unruptured amoebic liver abscess underwent emergency exploratory laparotomy because they presented as cases of acute abdomen. The initial diagnoses made by senior physicians included perforated duodenal ulcer, intestinal obstruction, cholecystitis and appendicitis. All patients had persistent draining sinuses after surgery for periods ranging from one to five months. Neither the trophozoites nor the cystic forms of Entamoeba histolytica were present in the "abscess" which was essentially necrotic liver tissue. The diagnosis of amoebic liver abscess was based on clinical features: typical "anchovy" or chocolate-coloured aspirate from the liver, response to anti-amoebic therapy and serological studies.
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PMID:Unruptured amoebic liver abscess presenting as acute abdomen. 687 89

Patients often present to the surgeon with abdominal pain, tenderness, and fever. Many exhibit progressive sepsis due to abdominal pathology. Delay in diagnosis and treatment often occurs due to the use of multiple, time-consuming, expensive diagnostic studies. We delineate the use of diagnostic laparoscopy in subsets of patients in whom confusion exists as to the cause of abdominal sepsis--i.e., females in child-bearing years, elderly patients, obese patients, immunosuppressed patients, and patients with suppression of physical findings. The methodical assessment of the entire abdominal cavity is performed utilizing manipulation of the patient's position (Trendelenburg, supine, reverse Trendelenburg, left side up, right side up) and meticulous inspection of the entire small bowel. Diagnoses included acute appendicitis, gangrenous appendicitis, perforated appendicitis with peritonitis or abscess, gangrenous cholecystitis, ischemic bowel disease, perforating carcinoma of the colon, perforating diverticulitis with abscess or peritonitis, tubo-ovarian abscess, closed-loop small-bowel obstruction, megacolon, and perforation of the colon. Laparoscopic treatment of 96% of the patients was performed successfully and a laparoscopic-assisted approach was used in the remainder. There was one mortality (cardiac) and no major morbidity. The development of a Formal Diagnostic Exploratory Laparoscopic (FDEL) approach has aided in the assessment of each of the diagnoses of sepsis in the abdominal cavity. The diagnostic and therapeutic approach laparoscopically avoids extensive preoperative studies, avoids delay in operative intervention, and appears to minimize morbidity and shorten the postoperative recovery interval.
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PMID:Use of laparoscopy in the diagnosis and treatment of patients with surgical abdominal sepsis. 759 89

We assessed bowel sounds in controls and patients with acute abdominal conditions using a new computer-aided sound analysis system (C.A.S.A.S.). Sixty-three controls and 61 patients with an acute abdomen had 10-min recordings of bowel sounds in a silent environment with computer analysis of the digitized acoustic signal. Mean bowel sound length was 20 +/- 1.3 ms in controls, 32 +/- 30 ms in cholecystitis, and 37 +/- 35 ms in intestinal obstruction (p < 0.05; mean +/- sd, Mann-Whitney U test). Similar significant differences existed between controls and acute abdomens in the number of sounds generated, sound intensity, and intervals between sounds. Although they were significantly longer in intestinal obstruction, bowel sounds were reduced in number (0.6 sounds/s) as compared to controls (0.4 sounds/s; p < 0.05). Significant differences were seen in all acoustic parameters in patients stratified for the presence or absence of peritonitis. C.A.S.A.S. allowed an objective scientific assessment of bowel sounds and identified significant differences between bowel sound patterns in controls and patients with an acute abdomen.
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PMID:Computerized phonoenterography: the clinical investigation of a new system. 818 10

The case of a 60-year-old woman with diabetes mellitus type II and primary hypothyroidism, who presented a clinical picture compatible with intestinal obstruction is reported. An abdominal sonogram revealed acute calculous cholecystitis and ileus. A plain film of the abdomen showed dilatation of small bowel loops. She underwent celiotomy, once stabilized, and gallstone ileus+cholecystoduodenal fistula were diagnosed intraoperatively. Resection of the ischemic segment of distal jejunum and the stone, cholecystectomy and primary repair of the fistula were performed. In spite of the systemic complications (metabolic, cardiovascular and pulmonary), that appeared postoperatively, the patient had a favorable outcome. This patient had an acute calculous cholecystitis and a spontaneous biliary-enteric fistula with intestinal obstruction, without previous symptoms of biliary tract disease preceding the episode of bowel obstruction.
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PMID:[Asymptomatic cholecystoduodenal fistula in a patient with diabetes mellitus and primary hypothyroidism: report of a case]. 829 19

From September 1986 to September 1994, 34 emergency laparotomies were performed in human immunodeficiency virus (HIV) seropositive patients. Patients were divided into 2 groups. Group A included 11 HIV seropositive patients without acquired immunodeficiency syndrome (AIDS). In these patients, indications for exploration included right lower quadrant pain consistent with appendicitis in 6 patients, right upper quadrant pain consistent with cholecystitis in 3 patients, small bowel obstruction in 1 patient, and blunt abdominal trauma in 1 patient. No postoperative deaths were observed. Group B included 23 AIDS patients. Indications for exploration were diffuse peritonitis in 8 patients, right lower quadrant pain consistent with appendicitis in 6 patients, right upper quadrant pain consistent with cholecystitis in 5 patients, bowel obstruction in 2 patients, diffuse abdominal pain in 1 patient, and massive rectal hemorrhage in 1 patient. The mortality rate in this group was 35% (8 out of 23 patients). Five of the 8 patients with diffuse peritonitis died postoperatively (62%). The importance of early diagnosis and prompt surgery is emphasized to improve the prognosis in AIDS patients, because of their poor general condition and the severity of abdominal complications.
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PMID:[Abdominal surgical emergencies in human immunodeficiency virus (HIV) infected patients. Apropos of 34 cases]. 878 19


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