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PubMed1975

Jaundice in patients with acute cholecystitis. Its validity as an indication for common bile duct exploration.

Our study demonstrates that (1) mild to moderate jaundice is frequently seen in patients with acute cholecystitis; (2) severe degrees of jaundice were seen in two patients without the presence of common duct stone or recognizable obstruction of the common bile duct; (3) only one of forty-one patients with acute cholecystitis had common bile duct stone; (4) jaundice does not appear to be a compelling reason for choledochotomy; and (5) less invasive technics such as intravenous and intraoperative cholangiography should suffice to exclude the possibility of common bile duct stone in patients with acute cholecystitis.

Acute Disease↗

PubMed1979

Acute cholecystitis complicating trauma.

Twelve patients developed acute cholecystitis complicating trauma. Acute acalculus cholecystitis was present in 11 patients. Nine patients died. A review of 20 reports comprising 98 patients shows 86.7% had acute acalculus cholelithiasis, and 61.1% had necrosis, gangrene, and/or perforation of the gallbladder. The overall mortality was 33.3% and only 16.1% of patients treated by cholecystectomy died. The etiology of acute cholecystitis complicating trauma is multifactorial. Gallstones are present infrequently whereas shock, increased bile pigment load, drugs, surgery, and (other) trauma are common precursors. Diagnosis is difficult and depends upon clinical suspicion and the physical examination. Immediate surgical intervention is required. Cholecystectomy is the procedure of choice. We recommend cholecystectomy at initial laparotomy whenever there is evidence of trauma to the gallbladder, or if the right or common hepatic artery is ligated for hepatic bleeding.

Adolescent↗

PubMed1978

The validity of 99mTc-pyridoxylideneglutamate (P.G.) cholescintigraphy as a diagnostic test for cholecystitis.

The purpose of this investigation was to determine the diagnostic value (validity) of technetium-99m-pyridoxylideneglutamate cholescintigraphy (99mTc-PGC) in patients with and without cholecystitis and to compare its validity to those of oral cholecystography (OC) and ultrasonography (US). 99mTc-PGC was applied to 50 patients with acute, subacute, and/or chronic cholecystitis with cystic duct obstruction proven histologically and operatively, and also to 27 non-diseased volunteers and 43 patients with right upper quadrant abdominal pain who subsequently were proven free of gallbladder disease. In addition, 38 patients had OC, and 31 had US performed. The results shows that the sensitivity and specificity of 99mTc-PGC were 100%. Whereas for OC the sensitivity was 87%, specificity was 100%. For US the sensitivity was 70%, and specificity was 93%. The repeatability of 99mTc-PGC, OC, and US were 100%, 97% and 81% respectively. These data show that 99mTc-pyridoxylideneglutamate cholescintigraphy is a valid diagnostic tool in the evaluation of patients with cholecystitis, and is also safe and simple.

Adolescent↗

PubMed1979

Lymph follicular cholecystitis.

Ten cases of cholecystitis with severe lymphocytic reactions were selected among serially examined 131 cases of cholecystitis or/and cholelithiasis. Gram-negative bacterial infection, especially E. coli and K. pneumonia seemed to be related as the cause of these severe lymphocytic reactions, but the gallstone revealed no definite influence. We would like to separate the cases with severe lymphocytic reactions as a lymph follicular cholecystitis and consider the possibility of a gram-negative bacterial infection in bile.

Adult↗

PubMed1978

Gas in the bile ducts (pneumobilia) in emphysematous cholecystitis.

Gas in the biliary ducts (pneumobilia) was demonstrated in three cases of emphysematous cholecystitis. Pneumobilia is usually secondary to a spontaneous internal biliary fistula or incompetent sphincter of Oddi, and is rarely considered a manifestation of emphysematous cholecystitis. The presence of gas in the biliary ducts in these cases suggests that the cystic duct is patent, allowing gas to escape from the gallbladder lumen. The pathophysiology of emphysematous cholecystitis is discussed and an ischemic etiology considered.

Adult↗

PubMed1975

Cholecystostomy for acute cholecystitis.

During the period from 1963 to 1970, 318 patients were subjected to early operation for acute cholecystitis. Cholecystostomy was performed in 25 cases (7.8 percent). Despite advanced age and associated serious illnesses, cholecystostomy was an effective and definitive method of treatment. Many of these patients are likely to succumb from intercurrent disease before they develop further stones or cholecystitis. A planned cholecystostomy may be the operation of choice for poor-risk patients with acute cholecystitis.

Acute Disease↗

PubMed1975

Acute cholecystitis.

The mortality rate for acute cholecystitis was 9.4 per cent. Those patients who underwent cholecystostomy had a mortality rate of 27.3 per cent, cholecystectomy 2.2 per cent, cholecystectomy and choledochotomy 7.4 per cent. Factors found to have an adverse effect on mortality in acute cholecystitis included sphincterotomy, perforation or gangrene of the gallbladder and cholagitis. Cholecystectomy is the operation of choice in acute cholecystitis in the absence of or history of jaundice or evidence of a common duct stone or cholangitis. Operative cholangiography and pressure and flow measurements through the cystic duct are advocated to avoid a retained common duct stone. Cholecystostomy should be reserved for the critically ill patient or a patient who deteriorates during operation, and it should be done only if the operator visualizes clear bile returning through the cystic duct.

Acute Disease↗

PubMedDate not supplied

[Acute cholecystitis in the clinical picture of acute food poisonings].

The authors followed up 215 patients with acute cholecystitis who were hospitalized with an erroneous diagnosis of food poisoning and 346 food poisoning patients who developed acute cholecystitis in the course of the disease mentioned. Symptoms for differential diagnosis of acute cholecystitis and food poisoning were considered.

Acute Disease↗

PubMed1979

[Acute emphysematous cholecystitis].

Emphysematous cholecystitis is a rare form of acute cholecystitis, characterized radiographically by the presence of gas within the gallbladder. We report of a patient, who was admitted to the hospital with the diagnosis of acute abdomen. This patient had an emphysematous cholecystitis caused by Clostridium perfringens. We found the wall of the gallbladder emphysematous and gangrenous, the gallbladder was distended and contained purulent material, but no stones. However, in addition, the films of abdomen showed gas in the ducts. Diagnosis, pathogenesis and the aetiological and therapeutical aspects will be discussed.

Acute Disease↗

PubMed1979

[Dynamics of the total proteolytic activity and kinin system components of the blood in acute cholecystitis].

Under study was the dynamics of changes of the activity of components of the kinin system and proteolytic activity of blood in 32 patients with acute cholecystitis. The results have shown that cholecystic patients and patients with the diseases of biliary ducts, especially in the exacerbation stage, have pronounced shifts in the kinin system components and in the proteolytic activity of blood as a whole. In clinical conditions the proteolytic activity data can be used for determining the severity and development of acute cholecystitis. The use of protease inhibitors in the inflammation of the gallbladder and biliary ducts results in a decreased blood proteolytic activity and thereby contributes to more rapid recovery of patients with such disorders.

Acute Disease↗

PubMed1979

Cholescintigraphy in the determination of disturbed hepatobiliary function in acute cholecystitis.

The hepatobiliary transit of 99mTc-diethyl-IDA was studied in 50 cases of acute cholecystitis. The intrahepatic transit was characterized by the liver mean transit time of the tracer. The extrahepatic passage through the biliary tract was assessed from a series of scintigrams. The data were classified according to previously obtained knowledge of normal and pathological states of the liver and the biliary tract. (Normal liver mean transit time less than or equal to 70 minutes, normal appearance-time of the tracer in the biliary tract less than or equal to 15 minutes and in the intestine less than or equal to 20 minutes, no retention of the tracer in the biliary tract in cases of later appearance-times). Abnormal hepatobiliary transit of the tracer was recorded in 27 cases; it was retarded at the intrahepatic level in 11 cases, at the gallbladder neck in 3 cases, distally in the biliary tract in 12 cases, and a tight extrahepatic obstruction was seen in 1 case. In consequence, acute cholecystitis is often associated with disturbed hepatobiliary function. The functional changes in acute cholecystitis were similar to those associated with other hepatobiliary disorders of either intrahepatic or extrahepatic origin.

Acute Disease↗

PubMed1979

[Salmonella-cholecystitis (author's transl)].

Gastroenteritis due to Salmonella enteritis is an endemic disease in our region, extraintestinal manifestations however are rare. We report a 8 years old girl who presented after 4 days of an unspecific diarrheal disease with watery liquid stools, vomiting, abdominal cramps, fever above 39 Grad C and symptoms and signs of an acute abdominal emergency. Mid abdominal laparotomy disclosed a cholecystitis with reactive peritonitis. Cultures of bile showed Salmonella group B as the causative organism. Cholecystectomy was performed, postoperatively Gentamycin later Chloramphenicol was administered. The postoperative course was unremarkable. Cholecystitis is a rare disease in pediatrics. Gallstones don't seem to play a roll in the etiology unlike in adults. It usually follow serious systemic infections or postoperatively after unrelated abdominal surgery due to overgrowth of the biliary system and organisms contaminating the upper gastrointestinal tract (biliary stasis, dehydration). Salmonella enteritidis as a cause of a cholecystitis is a rare event.

Child↗

PubMed1979

[The contribution of gallbladders' infusion tomography in the diagnosis of acute cholecystitis (author's transl)].

The detection of opacification of the wall of the gallbladder after the intravenous injection of hydrosoluble iodinated contrast medium (gallbladder parietography) was sought in 82 patients suspected of suffering from acute cholecystitis. In 35 cases, the examination was negative and operation or the clinical course made it possible to eliminate the diagnosis of acute cholecystitis. In 47 cases, it was positive. The diagnosis was confirmed in 39 cases out of 40 patients undergoing surgery. The appearance of the opacification makes it possible to distinguish two types of positive gallbladder parietography: -- with a thin wall and gallbladder of normal size, corresponding to moderate inflammatory lesions; -- with a thickened wall associated with a large gallbladder corresponding to major inflammatory lesions. The examination is simple, reliable, may be carried out as an emergency and combined with intravenous urography. The diagnosis of acute cholecystitis may be made in difficult causes, and appropriate therapeutic steps taken.

Acute Disease↗

PubMed1978

[Change in the amylase activity and microflora in the bile in cholecystitis].

To ground the surgical technic and pathognomic postoperative management some etiopathogenetic problems of acute cholecystitis have been studied. The gallbladder contents and abdominal cavity exudate and their effect upon the amylase activity and microflora have been analyzed. The analysis has shown that in the pathogenesis of acute cholecystitis in elderly and senile patients the fermentative component plays an important part, which results in a rapid destruction of the gallbladder against the background of vascular disorders. Such cases need an earlier decompression of the biliary tract and the postoperative management should be aimed at the suppression of pancreatic secretion. As to the majority of the cases of acute cholecystitis, which not infrequently possesses some features of a longlasting chronic process, the operation should be postponed till inflammatory manifestations subside.

Aged↗

PubMed1978

[Combined operations for cholecystitis (author's transl)].

An analysis of 60 operations for cholecystitis includes interventions accompanied by simultaneous procedures on various organs of the abdominal cavity, on the abdominal wall, the kidney and the heart. The problems of preoperative examination of patients with cholecystitis are discussed along with the surgical tactics when concomitant pathology requiring surgical management is revealed, and with indications for one-stage combined interventions in cholecystitis.

Cholecystitis↗

PubMed1978

Antibiotics in acute cholecystitis.

In 460 cholecystectomies performed for acute cholecystitis 215 (47%) positive gallbladder bile cultures were obtained. In 73% of emergency operations bacteria were recovered, in 48% of early operations (p less than 0.001) and in 29% of late operations (p less than 0.001). In vitro concentrations of 8-16 mcg/ml of ampicillin or cephalothin inhibited in most cases the growth of E. coli, Klebsiella and Enterococci, which comprised 75% of all strains isolated. One hour after intravenous infusion of 1 g ampicillin the mean serum level was 21 mcg/ml, the mean common duct level 16 mcg/ml and the mean gallbladder bile level 4.4 mcg/ml. In acute cholecystitis 2 g cephalothin gave mean concentrations of 14, 8, and 1.2 mcg/ml. Most of these patients had cystic duct obstruction both on intravenous cholegraphy and during operation. Control patients with patent cystic ducts who received ampicillin had mean gallbladder and common duct bile levels of 47 and 56 mcg/ml, and those receiving cephalothin 23 and 28 mcg/ml. It appears that adequate gallbladder bile concentrations of antibiotics are not attainable in acute cholecystitis because of the obstruction to the bile flow. The favourable results of prophylactic antibiotic treatment in reducing septic complications seem to depend more on adequate serum and tissue concentrations than on the concentration of antibiotics in the bile.

Acute Disease↗

PubMed1978

Abnormal liver function tests in acute cholecystitis; the predicting of common duct stones.

In a prospective series of 155 patients with acute cholecystitis preoperative liver function tests were determined with the aim of predicting the presence of common duct stones. Elevated serum bilirubin, aminotransferases and alkaline phosphatase levels were observed in 32, 34 and 22% of cases, respectively. The frequency of common duct stones was 17.4%. The sensitivity of bilirubin and aminotransferases with regard to ductal stones was higher (70-81%), but alkaline phosphatase showed the best predictive values (46%). The probability of common duct stones increased with higher degrees of elevation in the case of alkaline phosphatase, but not in the case of bilirubin or aminotransferases, A frequency of 31-67% of choledocholithiasis was found when one or all of the tests were positive. After random assignment the patients were operated on early or after delay. In the delayed surgery group more failures occurred in the conservative treatment of acute cholecystitis if the tests were elevated (36%) than if normal (15%, p less than 0.05). The frequencies of common duct stones were 11 and one in these groups (p less than 0.001). There was no increase in postoperative morbidity after early surgery (15%) compared with delayed surgery (22%, p greater than 0.1), when liver function was disturbed. Liver function tests thus allow patients with common duct stones to be selected for early surgery in acute cholecystitis.

Acute Disease↗

PubMed1977

Surgical treatment of acute cholecystitis.

A study of the results of surgical treatment of patients with acute cholecystitis showed that cholecystectomy is a safe procedure for the majority of patients during their initial hospitalization and avoids the risk of recurrent attacks and readmissions. Cholecystostomy has a limited place in the treatment of older patients with systemic disease and advanced local disease. Early aggressive management of acute cholecystitis will probably reduce complications of cholecystitis and reduce the need for cholecystostomy.

Acute Disease↗