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

Salient features of an operative technique designed to reduce to a minimum the iatrogenic trauma of cholecystectomy include a limited incision, muscle retraction (instead of division), specific packing and retraction, and distant manipulations by long instruments. Eighty two unselected consecutive patients with primary gallbladder disease underwent operation by this technique. Two permanently bed-confined patients were excluded from study. Acute cholecystitis was documented by histopathology review in 23 cases and chronic cholecystitis in 57 cases. Case material included usual pre-existing concomitant medical problems; five patients meeting formal criteria for the diagnosis of morbid obesity; 15 patients exceeding 199 pounds and one weighing 315 pounds; ambulatory (outpatient) cholecystectomy; 17 patients over 70 and four patients over 80 years of age; five gangrenous and one perforated gallbladders, and perigallbladder abscesses without gangrene in one case; and conspicuous absence of respiratory complications. Median and average incision length was 5.5 cm. There were no major and five minor complications. Recent experience demonstrated safe performance of elective cholecystectomy for chronic disease, regardless of degree of patient obesity, with median incision length 5 cm, median operative time 65 minutes and median post-operative hospital stay 2 days.
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PMID:Minimal trauma cholecystectomy (a "no-touch" procedure in a "well"). 336 59

The value of routine bacterial culture and gram staining of bile intraoperatively was investigated in 84 patients undergoing cholecystectomy. A positive bile culture was found in five of eight patients with an acute cholecystitis and in three of five patients with stones in the common bile duct, but in only nine of 66 patients with chronic cholecystitis without a common duct stone (14%). None of the patients with a normal gallbladder wall or cholesterolosis were bacteria-positive. Immediate microscopy of bile showed positive results in eight of 17 culture-positive bile specimens. As the majority of strains isolated from bile were aerobes sensitive to ampicillin and trimethoprim-sulphamethoxazole, any of these antibiotics can safely be administered intraoperatively to patients belonging to the risk group (acute cholecystitis, common bile duct stone). Immediate microscopy of bile is an unrealiable method of limited value and is not recommended for routine use.
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PMID:The significance of bacteriological findings at cholecystectomy. 346 Feb 89

Biliary complement concentrations and activity are lower in patients with infected bile than in those with sterile bile in cholecystitis. Plasma complement is increased during the acute phase response to inflammation. To determine whether low biliary complement in infected bile is a specific response to biliary tract infection or part of a general systemic reaction, we analyzed bile complement proteins (C3 and C4) and activity (C4H50) and acute phase reactants fibronectin, C-reactive protein, and alpha 1-antitrypsin concentrations in acute and chronic cholecystitis. Results were correlated with bile cultures and gallbladder histology using the Wilcoxon rank sum test. While biliary C3, C4, and C4H50 were significantly lower in infected bile than in sterile bile, none of the acute phase reactants were different. The biliary acute phase reactants were all significantly higher in acute cholecystitis than in chronic disease, but there was no difference in the biliary C3, C4, or C4H50 levels. There was no clear relationship between plasma levels of complement and the acute phase reactants. The dissociation between biliary complement and acute phase reactants indicates that bile complement is not a reflection of a systemic reaction to inflammation. We propose that biliary complement is a specific host defense mechanism against bacterial infection in the biliary tract.
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PMID:Complement in local biliary tract defense: dissociation between bile complement and acute phase reactants in cholecystitis. 349 84

Upper abdominal sonography was used as a routine emergency study to diagnose acute cholecystitis in 135 patients clinically suspected of having the disease. Ten radiologists with various experience in sonography performed the studies. Fifty-six patients had acute cholecystitis. Altogether 52 cholecystectomies were performed, mainly within 48 h of admission. Acute cholecystitis was diagnosed correctly in 52 cases (sensitivity, 93%) and excluded correctly in 75 cases (specificity, 95%; overall accuracy, 94%). Of the four patients with a false-negative study, calculi without signs of cholecystitis were detected in three, and distention and tenderness without calculi in one case. The final diagnoses in four false-positive studies were chronic cholecystitis in two cases, carcinoma of the gallbladder in one case, and pancreatitis in one case. The results of sonography as a continual emergency service provided by a staff with various experience are equal to those published in other studies performed mainly by an expert staff with long experience.
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PMID:The value of routine sonography in clinically suspected acute cholecystitis. 351 96

The prevalence of ultrasonographic (US) signs described in the literature in cases of acute cholecystitis (wall thickening, increased volume, roundness and local tenderness of the gallbladder, an anechoic layer in the gallbladder wall and cholelithiasis were studied in 136 consecutive patients referred for US examination with clinically suspected acute cholecystitis (AC). Of the patients, 56 had AC, 21 chronic cholecystitis, 2 carcinoma of the gallbladder, and 57 extrabiliary diseases. In AC, frequent findings in addition to cholelithiasis were wall thickening (79%) and an increased volume (64%). Almost one third of the patients had local tenderness (sonographic Murphy sign) (29%), and 27% of the gallbladders had a rounded form. All these features were, however, rather frequently detected also in chronic cholecystitis (5-33%) and in the 2 carcinoma patients, and also sporadically in extrabiliary diseases. A anechoic layer in the gallbladder wall was the only sign confined to AC, but was detected only in 2 cases. Roundness of the gallbladder occurred only in either acute or chronic cholecystitis. The combination of at least two diagnostic findings was noticed in 91% in AC, rather frequently in chronic cholecystitis (43%) and in both carcinoma patients, but only in 1 patient in the extrabiliary disease group. Three or more signs were seen only in gallbladder diseases (48%), but AC, chronic cholecystitis or carcinoma groups could not be completely differentiated (prevalences 63, 10 and 50%).
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PMID:Ultrasonography of the gallbladder in patients with a clinical suspicion of acute cholecystitis. 354 28

This study reviews 27 patients with nonvisualization of the gallbladder on cholescintigraphy. The preoperative diagnosis of acute cholecystitis was confirmed pathologically in 23. A rim of increased hepatic activity (RIHA) adjacent to the gallbladder fossa was seen throughout the study in 35% with acute cholecystitis and in no patients with chronic cholecystitis. Nine patients with "complicated" cholecystitis (defined pathologically as a late stage of the spectrum of acute cholecystitis) had a positive RIHA in contrast to no patients with "noncomplicated acute cholecystitis" (p less than 0.05). The sensitivity/specificity of the RIHA for "complicated" acute cholecystitis was 45%/100% and the positive/negative predictive value was 100%/39%. Liver tissue that was attached to the gallbladder by adhesions and removed at surgery was reviewed histologically and correlated with the presence or absence of a RIHA. The RIHA seems to be a useful indicator of patients presenting at a later stage of the pathologic spectrum of acute cholecystitis and perhaps at increased risk for complications.
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PMID:Prognostic value and pathophysiologic significance of the rim sign in cholescintigraphy. 366 62

A case of acute acalculous cholecystitis in which sequential hepatobiliary scintigraphy demonstrated apparent transient biliary obstruction is presented. An initial technetium-99m diisopropyliminodiacetic acid ([99mTc]DISIDA) study in a patient suspected of acute cholecystitis showed persistent hepatic activity, nonvisualization of the gallbladder, and minimal intestinal activity seen only at 24 hr. Following a second injection of [99mTc]DISIDA administered shortly after the 24-hr image from the first study, the gallbladder and bowel were both visualized within 75 min. At subsequent surgery, acute and chronic cholecystitis were present without evidence of choledocholithiasis or other source of obstruction. Intrahepatic cholestasis following clearance of biliary obstruction may result in late bowel visualization on delayed cholescintigraphic images similar to that seen in partial obstruction. Accurate reflection of the state of hepatobiliary function may require reinjection with [99mTc]DISIDA.
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PMID:Sequential hepatobiliary scintigraphy demonstrating apparent transient biliary obstruction. 366 69

The phenomenon of acute cholecystitis complicating an unrelated operation has been reported with increasing frequency, and may be preceded by a variety of operative procedures and a lack of previous biliary tract symptoms. Among eight such patients treated by us, seven developed acute cholecystitis postoperatively, and in one it was discovered during operation for bleeding duodenal ulcer. Two patients had undergone wide excision of the breast; two, highly selective vagotomy; one, nephrolithotomy; one, truncal vagotomy and gastroenterostomy; and one, left hemicolectomy and colostomy. In three patients, urgent cholecystectomy was performed, and four were treated conservatively with subsequent elective cholecystectomy. Histopathological studies revealed acute and chronic cholecystitis in all eight patients and cholelithiasis in four. One patient died in septic shock. Numerous contributing factors have been suggested, including hypovolemia and biliary stasis, as well as the presence of stones. It would appear that chronic cholecystitis or other biliary pathology, as found in our eight patients, is a major factor in the development of this manifestation.
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PMID:Acute cholecystitis complicating unrelated disease: etiological considerations. 367 95

Acute symptomatic biliary tract disease in the elderly is usually associated with a tenfold increase in operative morbidity and mortality when compared to the disease in non-elderly patients. Over a 10-year period 118 elderly patients with a mean age of 77.2 years (range 65 to 98 years) were operated on for benign biliary tract disease. Acute cholecystitis was found at operation in 33 patients (28%), empyema in nine (7.6%), gangrene of the gallbladder in three (2.5%), and 24 patients (20.3%) were found to have common bile duct stones. Seventy-three patients had chronic cholecystitis. Complications occurred in 29 patients (24.6%), with pneumonia and wound infection as the two most common. Fifteen patients died, making the overall mortality rate 12.7 per cent. The mean age of the patients who died was 81.5 years. Two patients died following elective operations (mortality rate 1.7%), while the remainder died after emergent or urgent operations (11%). Elective biliary tract surgery in the elderly for symptomatic disease is safe and will reduce postoperative morbidity and mortality.
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PMID:Symptomatic biliary tract disease in the elderly patient. 372 84

A prospective study of 11 patients who had undergone two sequential hepatobiliary scans prior to surgery demonstrated that initially positive scans could be due to acute cholecystitis, or chronic cholecystitis with exacerbation. A second hepatobiliary scan performed four to five days later differentiated acute from chronic cholecystitis. All five patients with surgery-proven acute cholecystitis remained hepatobiliary-positive, while patients with surgery-proven chronic cholecystitis reverted back to negative hepatobiliary scans if the second hepatobiliary scan was done properly.
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PMID:Does positive hepatobiliary scan in cholecystitis stay positive, and for how long? 376 23


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