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

Two series from greater Stockholm consisting of 726 (1960 to 1968) and 1,000 (1977 to 1978) patients over age 70 years with acute abdominal complaints are presented. Almost two thirds were women. Acute cholecystitis dominated both series, but its incidence decreased from 40.8 to 26 percent in the later series. The incidence of malignant disease increased from 3 to 13.2 percent. About one third of the patients were operated on; 50 percent had postoperative complications. Some frequently occurring aberrations of the usual symptoms and signs in acute appendicitis, ileus, and perforated gastric duodenal ulcer are discussed. The overall therapeutic results improved, as judged by postoperative mortality (series I, 23.1; series II, 16 percent) and mortality associated with individual diseases (except for acute pancreatitis). However, total mortality only decreased from 14 to 11.3 percent due to the large number of malignant diseases in series II, which were associated with a mortality of 37.9 percent. In series II the median duration of stay was 10.5 days and 75 percent of the patients were discharged home.
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PMID:Acute abdominal disease in the elderly: experience from two series in Stockholm. 709 11

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

Biliary diseases in the elderly results in two major problems: gallstone disease and malignant jaundice. Ultrasonography and direct cholegraphy via the transpapillary or transhepatic route are the appropriate diagnostic methods. "Open" or "minimal invasive" laparoscopic cholecystectomy is indicated in patients with symptomatic cholecystolithiasis requiring definitive treatment. Elderly patients will rarely be good candidates for conservative management with gallbladder stone fragmentation and/or dissolution. In patients with acute cholecystitis and gallstone ileus surgical intervention is recommended. Bile duct stones with or without gallbladder in situ are today an indication for endoscopic therapy. Most patients with malignant obstruction of the common bile duct, in whom operative resection is not advocated, may effectively be palliated by transpapillary or transhepatic stenting.
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PMID:[Biliary diseases in the elderly: diagnosis and therapy]. 769 81

Gallbladder stones remain asymptomatic over a long period. The biliary colic is the typical pain caused by these stones. Dyspeptic symptoms seem to be unrelated to the presence of gallstones. Acute cholecystitis, a serious complication of gallstone disease, spans a wide spectrum of clinical findings. The typical signs are right upper abdominal pain and tenderness, fever, leucocytosis and Murphy's sign. 35% of patients experience gallbladder empyema or perforation. Localized gallbladder perforation, characterized by high fever, severe right upper abdominal pain and tenderness and a palpable mass is often difficult to distinguish from acute cholecystitis. Free perforation into the abdominal cavity causes diffuse peritonitis. Gallbladder perforation into the lumen of an adjacent organ produces fistulas, mostly with minimal symptoms or a pain relief after decompression of the inflamed gallbladder. Air in the bile ducts and on some occasions bile-acid-induced diarrhea may result. Rarely, the perforation of large stones leads to an occlusion of the GI tract and results in a gallstone ileus. Common bile duct stones may be asymptomatic or cause bile duct obstruction with biliary colics and jaundice. Acute bacterial cholangitis characterized by Charcot's triad (pain, jaundice and fever) and the acute biliary pancreatitis with its typical symptoms are the serious complications of common bile duct stones, associated with a high mortality rate. The clinical manifestations of a gallstone disease and its complications reveal important diagnostic features, but the most important diagnostic features, modalities are the imaging procedures. They are decisive for an accurate therapy.
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PMID:[Clinical manifestations of cholelithiasis and its complications]. 776 32

Over a one year period (June 1992-June 1993), 260 patients (208 females and 52 males) with mean age of 37 years (range 13-80), underwent laparoscopic cholecystectomy (LC) for symptomatic gallstones. Thirty patients were admitted as emergency (20 acute cholecystitis, 10 acute pancreatitis). The procedure was performed successfully in 232 cases (89%). In 28 patients (18 electives, 10 emergencies), the procedure was converted to open for a variety of reasons, difficult anatomy being the commonest. Our mean operative time was 99.9 minutes (range 30-290 minutes). There were 3 major complications (2 common bile duct injuries and one abdominal aortic injury) and 4 minor complications (2 wound infections, one prolonged ileus and one chest infection). There was one death due to sickle cell crisis on the fifth post-operative day. The mean hospital stay was 2.3 days and 6.5 days for LC and converted cases, respectively. Our results suggest that laparoscopic cholecystectomy can be offered and conducted safely and effectively in the great majority of patients presenting acutely or electively with cholelithiasis, and that the results we achieved during the first year of our experience with LC is comparable to those reported from Europe and North America.
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PMID:Laparoscopic cholecystectomy: the Dammam Central Hospital experience. 853 Feb 20

Beginning in 1990, all patients encountered by the author requiring cholecystectomy were attempted by laparoscopy. This study reports the results of 83 patients with acute cholecystitis who were urgently treated, nonselectively, by laparoscopic cholecystectomy. Acute cholecystitis was diagnosed clinically by the presence of right upper quadrant peritoneal pain, gallbladder phlegmon and fever, and/or increased white blood cell count. In addition, a confirming pathology report and/or elevated white blood cell count was present in all 83 patients. Age ranged from 18 to 82 years with an average of 39.4 years. Fifteen patients were male and 68 female. Insufflation was obtained in all patients without a complication. Discharge occurred by postoperative Day one for 24 patients, Day two for 66 and by Day three for 75 patients (range 19-300 hours). No patient had common duct stones. Most patients had stones impacted in the cystic duct, including one patient who had Mirizzi's syndrome. Operative time ranged from 28 to 300 minutes, with an average of 106.3 minutes. No conversion to open cholecystectomy was required. Complications included bile spillage in five patients, stone spillage in ten, and ileus in three patients. One patient with Mirizzi's syndrome required a postoperative radiological procedure for removal of a cystic duct stone remnant that was not completely removed at the time of operation. The high complication rate initially associated with laparoscopic cholecystectomy probably resulted from violating cardinal principles of surgery, not from the inappropriateness of laparoscopy. In conclusion, it is recommended that urgent laparoscopy is an appropriate initial approach for patients with acute cholecystitis.
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PMID:Acute cholecystitis treated urgently by nonselective laparoscopic cholecystectomy. 865 59

Between 10% and 15% of the adult population have gallstones and therefore symptomatic cholelithiasis is the second most common indication for surgery in general practice. It's diagnosis depends on the patients history, clinical findings, laboratory tests and ultrasound. In case of symptomatic gallstones surgery offers the only permanent cure and specific complications due to gallstones such as ileus or fistula are becoming rare. With the introduction of minimal invasive surgery at the end of this century laparoscopic cholecystectomy is now considered to be the standard treatment for symptomatic gallstones. This approach can be offered to > 90% of patients in elective cases and in between 60%-80% of patients having acute cholecystitis with a low morbidity and mortality rate. The main advantages of the laparoscopic approach are the overall increased patients comfort with less postoperative pain, shorter hospital stay, recovery and off work time. Although the rate of common bile duct injury appears to be increased using this minimal invasive approach, this rate is still sufficiently small to justify the use of laparoscopic cholecystectomy for symptomatic disease. Open cholecystecomy remains the treatment of choice for complicated gallstone disease (i.e. cancer, Mirizzi syndrome, severe inflammation) and high risk patients. In case of acute cholecystitis the laparoscopic treatment with all it's advantages may also be offered to many patients. However, in those cases the conversion rate to the open approach may be markedly increased which has not to be considered as a complication of the laparoscopic approach but as a maximization of safety and effectiveness of the treatment.
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PMID:[Cholelithiasis--laparoscopy or laparotomy?]. 954 53

This was a prospective analysis of the first 162 patients who underwent biliary and nonbiliary minimally invasive (video laparoscopic) procedures in the Royal Commission Medical Centre (RCMC) over two periods separated by a one year interval (September 1993-September 1994)-(October 1995-February 1996). One hundred and fifty patients had video laparoscopic cholecystectomy (VLC). Thirty four males and 116 females with a mean age of 39.7 years (range 16-80). Forty two patients (28%) were admitted as emergency (37 acute cholecystitis, 5 acute pancreatitis). The indication for VLC was symptomatic gall stones. The VLC was accomplished successfully in 144 patients (96%). Six patients (2 electives and 4 emergency) required a conversion for various reasons, unfavourable anatomy being the commonest. Ten patients with preoperative evidence of a dilated common bile duct, with or without stones had an ERCP done in another hospital 200 km away. The median operative time was 100 minutes (range 30-270 minutes) There were three major complications (one CBD injury, one bleeding from gall bladder bed and one post operative acute pancreatitis) and 6 minor complications (urethral bleeding, atelectasis post-operative pyrexia, umbilical port cellulitis, prolonged ileus and acute anxiety state). The median hospital stay was 72 hours for successful VLC. Twenty five per cent of the patients did not require any narcotic analgesic. Twelve patients (7.4%) had one or another non-biliary video laparoscopic procedure. Our results suggest that VLC can be offered and performed safely in the majority of patients presenting with acute and/or chronic cholecystitis and that the results we achieved in a district hospital are comparable to other series. We conclude that VLC will continue to be demanded by patients and non-biliary video laparoscopic procedures which were slow to develop in our hospital will continue to need special training, interest and expertise before it can be adopted as a routine.
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PMID:Minimal invasive surgery: a district hospital experience. 974 97

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

Gallstone is a common disease with a 10% prevalence in the United States and Western Europe. However, it is only symptomatic in 20-30% of patients, with biliary pain "colic" being the most common symptom. Complications of asymptomatic gallstone disease are generally rare, with an incidence of <1 %/yr. The most common complications of gallstone disease are acute cholecystitis, acute pancreatitis, ascending cholangitis, and gangrenous gallbladder. Less frequent complications include Mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus. Mirizzi syndrome and cholecystocholedochal fistula are two manifestations of the same process that starts with impaction of a gallstone in the gallbladder neck that results in obstruction of the bile duct, causing jaundice. The gallstone may erode into the bile duct, causing cholecystocholedochal fistula. Gallstone ileus refers to small bowel obstruction resulting from the impaction of one or more gallstones after they have migrated through a cholecystoenteric fistula. An accurate diagnosis is essential to the management and prevention of further complications. A variety of imaging and endoscopic modalities are used to make the diagnosis once the condition is suspected clinically. Treatment should be tailored to each individual patient. Management choices include ERCP, lithotripsy (endoscopic or extracorporeal), and surgery. Prognosis is frequently related to early recognition, management of any comorbid conditions, and careful selection of treatment modalities.
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PMID:Complications of gallstone disease: Mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus. 1213 51


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