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

Between 1950 and 1980, a total of 145 patients with pain-free gallstones in the gallbladder and open cystic duct were followed for a mean observation period of 13.5 years. Pigment stones made up 25.5% of the total, cholesterol the rest. Growth of stones was noted in 70% of cases, new stones in 14%, and calcification in 25%. Colics occurred in 29%, severe ulcerative cholecystitis in 4% and passage of stones with pancreatitis in 5.5%. Constant cystic duct occlusion occurred in 18%, causing mild gallbladder inflammation in 40% of them. Cholecystectomy should be limited to large, old stones, to prevent gallstone ileus. Recently formed cholesterol stones should be removed as soon as possible by litholysis. Otherwise expectant waiting with regular follow-up is indicated.
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PMID:[Changes in silent gallbladder stones. Roentgen-diagnostic and symptomatologic observations over 30 years]. 373 71

Percutaneous cholecystostomy can be a useful technique for the ill, elderly, or high-risk patient, since he or she is spared open surgery. We used it successfully in a medically unstable woman with acute acalculous cholecystitis. Her drainage catheter, often the source of complications with the procedure, may have been removed too early: A small asymptomatic subdiaphragmatic fluid collection and ileus developed. However, both resolved in 48 hours.
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PMID:Percutaneous cholecystostomy in patient at high risk. Treatment of acute acalculous cholecystitis. 380 37

Ultrasonography is an effective and accurate diagnostic test for acalculous cholecystitis. Until recently, however, little attention was focused on the gallbladder wall as an indicator of disease. By accurately visualizing and measuring the gallbladder wall, ultrasonography can be used to screen patients in whom acute acalculous cholecystitis is suspected. If the gallbladder wall measures 3.5 mm or greater, in the absence of ascites, a diagnosis of acalculous cholecystitis can be made safely with a specificity greater than 98 percent. Four of our five patients with acute acalculous cholecystitis had ultrasonically measured gallbladder walls 3.5 mm or greater in width. We have found ultrasonography useful in any clinical situation, even in the face of ileus, jaundice or pancreatitis. In addition, with the use of the portable real-time ultrasound machine, postoperative, traumatized and other critically ill patients can be examined at the bedside.
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PMID:Acute acalculous cholecystitis. Ultrasonic diagnosis. 725 43

1775 patients with symptomatic cholecystolithiasis were treated by laparoscopic cholecystectomy without selection or contraindications. Complications should be compared with those of conventional cholecystectomy. 73.5% of our patients were female, the median age was 62 years (min. 9, max. 91 years). They presented uncomplicated cholecystolithiasis in 85%, acute cholecystitis in 11% and cirrhotic gallbladder in 4.5%. The rate of conversion to laparotomy was 2.9% for uncomplicated cholecystolithiasis and 11% for each cholecystitis and cirrhotic gallbladders. In general 4.4% were converted. These conversions were due to complications in 0.9% (bile duct lesions 0.7%, bowel perforation 0.2%), due to adhesions or inflammatory alterations in 3%. Perioperative letality was 0.3%, but only 0.15% were related directly to the operation. Other complications were bile duct strictures 0.3%, postoperative hemorrhage 0.3%, ileus 0.2%, perforation of diaphragm/pneumothorax 0.1%. Suspected bile duct stones were proved and treated by preoperative ERCP in 5.6%. Routinely performed intraoperative cholangiography detected unsuspected stones in 4%. These were removed mostly by postoperative ERCP. We consider laparoscopic cholecystectomy a safe method for the treatment of every stage of symptomatic cholecystolithiasis. There are no contraindications, if the operation is performed by an experienced team. Intraoperative cholangiography should remain standard. Complications in unselected patients are comparable to those of conventional cholecystectomy. The rate of bile duct lesions is equal (0.7%), a further decrease is expected (learning curve). According to this data, it is no longer justified, to perform cholecystectomy primarily by laparotomy, if there is experience with the laparoscopic method. Laparotomy by itself is no complication, it should be applied only, if the surgeon considers the operation inadequate to be continued laparoscopically.
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PMID:[Laparoscopic cholecystectomy: a prospective study of 1,775 unselected patients]. 761 Jul 21

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 the surgical point of view acute abdominal pain is the cardinal symptom of acute abdomen. Additional leading symptoms of acute abdomen are tension of the abdominal wall, peristaltic disorders and, in rare cases, shock symptoms. Acute abdomen is an operational diagnosis for painful, in part life threatening diseases of various etiologies. The most frequent cause is acute appendicitis, followed by cholecystitis and by diverse forms of ileus. These three diseases together are the cause of acute abdomen in more than 80% of cases. Over 90% of cases with acute abdomen are treated surgically. The decision in favour of a surgical intervention must be determined within minutes to hours depending on the etiology. A delay may lead to further, partly most serious sequelae.
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PMID:[Acute abdominal pain. Surgeon's viewpoint]. 908 28

Thirty-one patients with biliary enteric fistula who were operated on over a 19-year period (1976-1994) with an incidence of 0.74% in all biliary tract operations were reviewed retrospectively to identify etiologic factors, types of fistulas, signs and symptoms, methods of diagnosis, management and prognosis of the cases. Most common symptoms were abdominal pain, nausea, vomiting and jaundice. Two patients had gallstone ileus. The majority of the patients had severe concomitant medical illnesses. The exact preoperative diagnosis of a biliary enteric fistula was established in only five (16%) patients. In 81% of the cases fistula was secondary to chronic calculous biliary tract disease. Postoperative complications included wound infection in six (19%), biliary fistula in two (6%) and erosive gastritis in one (3%) patient. Two patients died of intra-abdominal sepsis and two of cardiac failure, with an operative mortality of 13%. Early elective cholecystectomy is recommended to avoid complications of chronic calculous cholecystitis such as bilioenteric fistulas and their increased mortality and morbidity.
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PMID:Biliary enteric fistulas. 937 75

Acute acalculous cholecystitis (AAC) is a rare and dangerous complication of various medical and surgical conditions. We report on a male patient with bile panperitonitis caused by gangrenous AAC, which developed while he was on total parenteral nutrition (TPN) for ileus related to obstructive colon cancer. We also review the relevant Japanese literature on AAC associated with TPN. Our patient suddenly developed right hypochondrial pain after 3 days of TPN while waiting for colon cancer surgery. We diagnosed acute AAC by ultrasonography, and salvaged the patient by cholecystectomy plus left colectomy. Early diagnosis by ultrasound is important for this critical condition. Knowledge of the risk of acute gangrenous cholecystitis during TPN may allow the physician to provide an appropriate diagnosis and treatment.
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PMID:Acute acalculous cholecystitis in a patient on total parenteral nutrition: case report and review of the Japanese literature. 1052 69

Gallstone ileus is a rare complication of recurrent gallstone cholecystitis. The classic radiographic triad of small bowel obstruction, pneumobilia and ectopic gallstone on abdominal plain radiograph is described with CT imaging. Because of the better resolution of CT compared with abdominal radiography and its recent accession to emergency use, radiologists should be aware of CT findings of gallstone ileus. We report a case in which gallstone ileus was initially diagnosed by CT.
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PMID:Gallstone ileus: CT findings. 1087 7

Patients with a diagnosis of acute cholecystitis need to be hospitalized, with surgery (ie, cholecystectomy) being the treatment of choice. While hospitalized, they should be treated with intravenous hydration and with intravenous antibiotics covering enteric organisms. They should receive nothing by mouth and may require a nasogastric tube if ileus is present. The use of such conservative management for 24 to 48 hours allows the inflammatory and infectious processes to "cool down." Early surgery performed right after this initial period of conservative therapy is preferred over delayed surgical management (ie, discharge of the patient and readmission for the surgery 6 to 8 weeks later). Several studies have shown that early cholecystectomy not only has no adverse effects on complication rates but also leads to shorter hospital stays and quicker return to productivity. Laparoscopic cholecystectomy is the preferred operation because it is associated with a shorter hospital stay, less pain, and earlier return to productivity than is open cholecystectomy. There is an increase in the frequency of bile duct injury with this procedure, however. In patients who are poor surgical candidates, cholecystostomy can be performed via percutaneous catheter drainage of the gallbladder with the patient under local anesthesia. In addition, endoscopic transpapillary drainage with or without gallstone dissolution (methyl tert-butyl ether ) has been demonstrated to be an effective alternative to surgery in high-risk patients with acute calculous cholecystitis.
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PMID:Acute Cholecystitis. 1109 85


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