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Query: UMLS:C0149520 (acute cholecystitis)
 2,784 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirty-two consecutive patients with impacted ampullary or distal common bile duct stones were managed prospectively. Preoperative indications for surgery were obstructive jaundice in 13 patients (40.6%), acute cholangitis in 7 patients (21.9%), biliary pancreatitis in 6 patients (18.8%), acute cholecystitis in 5 patients (15.6%), and chronic cholecystitis in 1 patient (3.1%). No patient had a prior cholecystectomy, and all stones were removed retrograde during cholecystectomy and open-duct exploration. There were no deaths, one retained stone in the biliary radicals, two episodes of mild pancreatitis, one superficial wound infection, and one minor bile leak. All patients have done well on follow-up. This study demonstrated that impacted biliary stones can be consistently and successfully extracted by the supraduodenal approach with minimal morbidity and no mortality, without resorting to duodenotomy and sphincter ablation.
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PMID:The surgical management of impacted common bile duct stones without sphincter ablation. 267 92

Roentgenological, radionuclide, ultrasound and thermographic methods were evaluated in 31 patients with acute and 85 with chronic cholecystitis. It was established that the succession of using of the above methods depends on the course of cholecystitis. In acute cholecystitis examination is begun with thermography and terminated by ultrasound. In chronic cholecystitis ultrasound is the first method to be followed by radionuclide methods. If necessary infusional cholegraphy and thermography are employed.
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PMID:[The radiodiagnosis of acute and chronic cholecystitis]. 269 88

Uptake of radionuclide by the liver next to the gallbladder in cholescintigraphy has been described as a useful secondary sign with a high positive predictive value for the diagnosis of acute cholecystitis. We retrospectively examined 780 consecutive cholescintigrams to (1) determine the positive predictive value at 1 hr of this sign for acute cholecystitis and (2) ascertain if the presence or absence of this finding could differentiate acute from gangrenous cholecystitis. Pericholecystic hepatic activity was present at 1 hr in 48 (34%) of 141 scans in which the gallbladder was not visualized, and cholecystectomy was performed within 6 days of scintigraphy. Forty-five of these patients had acute and three had chronic cholecystitis (94% positive predictive value for acute cholecystitis). In addition, 57% of patients with gangrenous cholecystitis exhibited pericholecystic hepatic activity, and the frequency of this finding was significantly higher (p less than .006) in gangrenous than in acute cholecystitis. In summary, pericholecystic hepatic uptake is a valuable secondary sign in the cholescintigraphic diagnosis of acute cholecystitis. The significance of the finding is (1) a high positive predictive value for acute disease at 1 hr and (2) a statistically significant increased frequency in patients with gangrenous cholecystitis.
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PMID:Diagnosis of acute cholecystitis by cholescintigraphy: significance of pericholecystic hepatic uptake. 271 56

A retrospective study 94 cases of elderly patients with biliary tract disease. The overall postoperative mortality rate was 6.4%. Among the 94 cases there were 50 cases of acute cholecystitis, of which 15 cases were complicated by acute obstructive suppurative cholangitis, and 44 cases of chronic cholecystitis. 80 cases had gallstones (85.1%). Associated diseases were found in 56 cases (59.6%) before operation, most of them were cardiovascular diseases (53.2%). During operation 23 cases were monitored by ECG, and abnormal ECG developed in 6 cases although the operations were all carried out uneventfully. It is suggested that after adequate preoperative preparation, aggressive surgical intervention should be considered for acute biliary tract disease in elderly patients.
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PMID:[Surgical treatment of biliary tract disease in elderly patients]. 277 55

This study reviews the cases of 15 patients with severe cardiac disease treated with the intra-aortic balloon pump (IABP) to improve cardiac status so that they could undergo definitive cholecystectomy. The 14 men and one woman ranged in age from 49 to 74 years. Indications for cholecystectomy included acute cholecystitis in nine patients and chronic cholecystitis in six patients. All patients had prior myocardial infarction, and in two patients this had occurred within 2 months of operation. All patients were Goldman's Class IV. Eight had severe cardiomyopathy. Mean ventricular ejection fraction was 21% +/- 3%. Cardiac index was 2.2 +/- 0.2 L/m/m2, and pulmonary artery pressure (PAP) was 51 +/- 5/23 +/- 2 mm Hg. After IABP placement, pulmonary wedge pressure decreased in all patients, from 24 +/- 3 mm Hg to 16 +/- 2 mm Hg (p less than 0.01). PAP systolic pressure decreased to 38 +/- 3 mm Hg (p less than 0.01), and PAP diastolic pressure decreased to 18 +/- 2 mm Hg (p less than 0.05). All patients had cholecystectomy. Five patients had intraoperative cholangiography. One of these five patients had a common bile duct exploration, and another underwent cystgastrostomy. Two patients died postoperatively of arrhythmias. Thirteen patients are alive 3 months to 7 years after operation, without biliary symptoms. Three patients have had orthotopic heart transplants. We conclude that IABP significantly improves cardiac performance so that many patients who have severe cardiac disease can undergo definitive biliary surgery.
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PMID:Placement of intra-aortic balloon pump allows definitive biliary surgery in patients with severe cardiac disease. 206 79

Seven cases of the Curtis-Fitz-Hugh syndrome diagnosed over a six month period are reviewed with particular reference to the widely ranging modes of presentation. All presented as acute surgical emergencies but unlike other series, right upper quadrant pain was the presenting symptom in only one case. Right upper quadrant pain nonetheless, featured to a variable extent in all cases, being relatively shortlived in three. Conditions mimicked included left renal colic, acute appendicitis, pulmonary embolism, acute cholecystitis, chronic cholecystitis and urinary tract infection. In five cases symptoms dated back to a difficult or complicated termination of pregnancy and in one case a hysterectomy had been performed twelve years previously at which time the patient had documented evidence of pelvic inflammation. Diagnosis was made laparoscopically and all symptoms responded satisfactorily to a four week course of tetracycline.
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PMID:Curtis-Fitz-Hugh syndrome: the new mimicking disease? 294 32

Sonograms of 412 consecutive patients with operatively and histologically proven acute or chronic cholecystitis were reviewed retrospectively. 267 of them had been operated on in an acute phase of gallbladder disease and 145 had undergone an elective operation. 236 patients had an operative and/or histological diagnosis of acute cholecystitis and 176 both operatively and histologically confirmed chronic cholecystitis. A thickened gallbladder wall was seen in 80% of acute cases, wall sonolucency in 39%, dilated gallbladder in 60%, sludge in 26% and stones in 75%, the corresponding proportions of the chronic cases being 18%, 4%, 12%, 13% and 93%. A contracted gallbladder with stones was seen in 15% of the chronic and 1% of the acute cholecystitis cases. 90% of the acute cases had two or more sonographic abnormalities, whereas 70% of the chronic cases had only one abnormality, most frequently gallstones. Only one normal sonographic finding was recorded in each group.
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PMID:Ultrasound in acute and chronic cholecystitis. 303 8

As a result of important advances in medical imaging, the oral cholecystogram is no longer the primary test of gallbladder function and anatomy. Real-time ultrasonography and cholescintigraphy, both highly sensitive and specific tests, are the two major methods for assessing gallbladder pathology. Oral cholecystography, endoscopic retrograde pancreatography, and percutaneous gallbladder puncture serve as supplementary tests. Decisions about which test to use depend on the kind of gallbladder disease that is suspected as well as the estimated likelihood of the disease before the information is obtained from the procedure. Thus, ultrasonography is the test of choice for chronic cholecystitis, with oral cholecystography reserved for situations in which the diagnosis is uncertain after ultrasonography. When acute cholecystitis is suspected, ultrasonography is also the test of choice in most patients, and cholescintigraphy is used to resolve uncertainty.
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PMID:How to image the gallbladder in suspected cholecystitis. 305 70

The medium-term effect of cholecystectomy on common bile duct diameters (CBD) was investigated prospectively in 64 patients with gallstone disease examined by ultrasonography immediately before and 27 months to 39 months after the operation. In 32 patients with chronic cholecystitis and patent cystic ducts, CBD diameters increased slightly (median 4.6 mm pre- and 5.3 mm postoperatively; p less than 0.05). A group of 19 patients with acute cholecystitis or cystic duct occlusion showed a significant decrease (median 7.7 mm pre- and 5.5 mm postoperatively; p less than 0.05). In 13 patients with common bile duct stones, the CBD diameters also decreased significantly after surgical intervention (median 7.5 mm pre- and 5.0 mm postoperatively; p less than 0.05). The widest CBD diameter after cholecystectomy observed in this study was 10 mm. We conclude that either increases or decreases of the CBD diameters may occur after cholecystectomy in patients with calculous gallbladder disease, and that the postoperative evolution is governed by the exact nature of the underlying biliary disease at the time of the index operation.
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PMID:Effect of cholecystectomy on common bile duct diameters: a longitudinal prospective ultrasonographic study. 314 22

To assess the pathological basis of the changes seen on ultrasound examination of the gallbladder wall in cholecystitis, the appearances of the gallbladder wall were analysed in 17 patients with acute cholecystitis and 27 patients with chronic cholecystitis, and correlated with the pathological specimens removed at surgery. A thin echo reduced layer within the echogenic gallbladder wall corresponds to a complex of subserosal oedema, haemorrhage and inflammatory cell infiltration, or to muscular hypertrophy. Indistinctness or a low echogenicity rind along the inner margin represents mucosal sloughing or obliteration of the mucosal folds. Uniformly decreased echogenicity of the wall is caused by severe inflammatory change with sloughing of the mucosa or obliteration of the mucosal folds. These ultrasound signs are considered to be valuable signs of cholecystitis.
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PMID:Ultrasound changes of the gallbladder wall in cholecystitis: a sonographic-pathological correlation. 330 88


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