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[Cholelithiasis: indications for treatment].

The bases of the current, generally accepted indications for treatment of cholelithiasis are summarized in this article. Asymptomatic gallstones and gallstones with typical symptoms and biliary complications have to be distinguished for an individualized treatment. In asymptomatic cholelithiasis, the formerly recommended prophylactic cholecystectomy has been replaced today by an expectative attitude. Recurrent typical colics require cholecystectomy. Nonsurgical treatments of gallstones are limited to exceptional situations. Gallstones in the bile duct require treatment almost always. They may be removed by surgery or endoscopy. Biliary complications require a rapid intervention.

Cholecystectomy↗

[Radiologic endoscopy of the biliary system in cholelithiasis].

Roentgenoendoscopic interventions combining diagnostic and therapeutic procedures were carried out in 320 patients with various pancreatobiliary diseases. Different combinations of therapeutic roentgenoendovascular interventions on the biliferous system are shown, which were used in 102 patients with clolelithiasis. These interventions were found a highly effective method for preoperative treatment and therapy of patients with cholelithiasis. Roentgenoendovascular interventions in cholelithiasis are conductive to optimization of surgical treatment.

Adult↗

Evidence for an association between cholelithiasis and hiatus hernia.

A prospective, controlled study was carried out to determine if there was an association between hiatus hernia and cholelithiasis. The prevalence of gallstones was calculated in 100 patients (50 men and 50 women) with radiological evidence of hiatus hernia. 100 subjects (50 men and 50 women) without hiatus hernia, matched for age, body-weight, and number of pregnancies, acted as controls. Gallstones were twice as common in the former group (34%) as in the control group (17%) (P less than 0.01). Moreover, a comparison of the lipid composition of the gallbladder bile in 15 subjects operated on for hiatus hernia with that in 17 patients operated on for another digestive disease showed that the molar percentage of choelsterol in the bile and the cholesterol saturation index were significantly higher in the patients with hiatus hernia (9.3 +/- 1.1, mean +/- S.E.M., 1.41) than in the control subjects (5.9 +/- 0.5; 0.97) (P less than 0.01). These results suggest an association between hiatus hernia and cholelithiasis. It is likely that common factors, probably related to a low-residue diet, predispose to the two diseases.

Bile↗

[Cholelithiasis in childhood. A report of 4 clinical cases].

Cholelithiasis is a frequent disease in infancy, more than what is generally thought. It is often associated with hemolytic disease, overnutrition, congenital abnormality of the biliary tree, systemic infection in newborns, prolonged total parenteral nutrition, sometimes without anyone known predisposing factor. Four patients with cholelithiasis are described, presenting various pathogenesis and clinical characteristics.

Acute Disease↗

Comparison of aged and young adult patients with cholelithiasis: a prospective controlled study.

BACKGROUND: Surgical operations for gallstones are associated with increased perioperative mortality in the elderly. The presence of pre-existing cardiovascular disease and acute cholangitis might be the cause as found in the literature. METHODS: From August 1989 to December 1990, twenty-nine patients (Age > or = 70 years) with cholelithiasis undergoing biliary surgery in Veterans General Hospital-Taipei were collected as experimental group. Twenty-nine patients from 62 patients (Age < or = 50 years) with cholelithiasis were selected as control group. The basic data, symptomatology, blood biochemistry, peri-operative complications, mortality and gallstone compositions were analyzed and compared between both groups. RESULTS: There was a higher male to female ratio (4.8:1) in the aged group. Aged patients had higher incidence of common bile duct stone (11/29 versus 3/29, P < 0.025), while young adult patients had higher incidence of intrahepatic stone (1/29 versus 10/29, P < 0.05). The perioperative morbidity and mortality was higher in the aged group (37.9% and 3.4%) as compared with the young age group (3.4% and 0%, P < 0.005). CONCLUSIONS: Aged cholelithiatic patients were associated with male preponderance, more common bile duct stones, higher perioperative morbidity and mortality, as compared with the young adult cholelithiatic patients.

Adult↗

Cholelithiasis in pancreas and kidney transplant recipients with diabetes.

BACKGROUND: Vascularized pancreas transplantation (PTx) for type I diabetes mellitus results in euglycemia at the expense of chronic immunosuppression, hyperinsulinemia, and dyslipidemia. However, the effect of PTx on native biliary lithogenesis remains unknown. METHODS: To address this issue, we retrospectively studied 72 consecutive pancreas transplant recipients and compared them with patients both with (n = 35) and without (n = 52) diabetes mellitus undergoing kidney transplantation alone (KTA). All patients underwent pretransplantation abdominal ultrasonography, which was repeated at 6- to 12-month intervals after transplantation. PTx recipients were managed with quadruple immunosuppression with OKT3 induction. Kidney transplant recipients received cyclosporine and prednisone. RESULTS: Seventeen (30.4%) of 56 evaluable PTx recipients had gallstones at a mean interval of 13 months (range, 5 to 24) after PTx. Eleven patients underwent open cholecystectomy (with one surgical exploration of common bile duct for choledocholithiasis), three underwent laparoscopic cholecystectomy, and the other three are being managed expectantly. Gallstone analysis revealed predominantly cholesterol stones. The incidence of cholelithiasis in kidney transplant recipients with and without diabetes mellitus was 27.3% and 12.2%, respectively (p = 0.04). CONCLUSIONS: Pancreas transplant and kidney transplant recipients with diabetes are predisposed to the development of gallstones compared with recipients without diabetes. An interaction between diabetes mellitus-induced gallbladder dysmotility and cyclosporine-induced cholestasis may be a possible mechanism. We recommend serial ultrasonographic examinations in pancreas transplant and kidney transplant recipients, and cholecystectomy in pancreas transplant recipients with cholelithiasis should be considered.

Adult↗

Cholelithiasis: current treatment options.

Up to 20 percent of the U.S. population may have cholelithiasis, but most of these persons remain asymptomatic. If symptoms or complications develop, several potential management strategies may be used. Open and laparoscopic cholecystectomy are definitive surgical treatments. Nondefinitive methods, such as lithotripsy, indirect dissolution, direct dissolution, sphincterotomy and drainage, have lower success rates but may be indicated in specific cases. Although laparoscopic cholecystectomy is a relatively new technique, its morbidity and mortality rates are comparable to those of open cholecystectomy, and it tends to be less expensive than other surgical methods. For these reasons, laparoscopic cholecystectomy is rapidly becoming the surgical method of choice in the treatment of cholelithiasis.

Cholecystectomy↗

Clinical and biochemical study of 114 cases of cholelithiasis.

During a period of 16 months 114 patients with cholelithiasis were studied. The diagnosis was confirmed by cholecystogram in 41 cases, by surgery in 28 and both surgery and the x-ray in 45 cases. There were 100 females and 14 males and their average age was 43.2 years. The average number of pregnancies in females was 6.5. Clinically the jaundice was observed in 9% and the gall bladder was palpable in 47% of cases. Cholelithiasis appeared to be related to increased parity but not to the body weight.

Adult↗

Cholelithiasis of the ovary.

BACKGROUND: Laparoscopic cholecystectomy is becoming a popular surgical option in the management of gallstone disease. Reports on complications of this procedure have usually focused on prolonged operative time, bleeding, and infections. We describe a case of cholelithiasis of the ovary following laparoscopic cholecystectomy. CASE: A 70-year-old woman, para 5-0-0-5, presented with a 2-month history of a pelvic mass following a laparoscopic cholecystectomy. Exploratory laparotomy demonstrated a 4 x 4-cm para-ovarian cyst as well as multiple rectal and pelvic implants. Pathologic findings confirmed gallstones of the ovary and pelvic peritoneum. These gallstones elicited mesothelial proliferation, local hemorrhage, and adhesion formation. CONCLUSION: The pathologic consequences of pelvic cholelithiasis can be marked. This was demonstrated in a postmenopausal woman, but has direct implications for the premenopausal patient as well. Our experience suggests that gallstones lost during laparoscopic cholecystectomy should be removed if possible.

Aged↗

Cholelithiasis in dogs: 29 cases (1980-1990).

Medical records of 29 dogs with cholelithiasis were reviewed. Aged female small-breed dogs were overrepresented. Mean age was 9.5 years, and mean weight was 12 kg. Vomiting, anorexia, weakness, polyuria/polydipsia, weight loss, icterus, fever, and signs of abdominal pain were the most common clinical signs. Leukocytosis, neutrophilia with left shift, monocytosis, high activity of serum hepatic enzymes, hypoalbuminemia, and high concentrations of serum total bilirubin were common. Radiopaque choleliths were evident on abdominal radiography of 13 of 27 dogs. Microbial culturing of bile isolated organisms in 15 of 20 dogs. Gram-negative bacteria were most common. Surgery was performed in 22 dogs. Four dogs were treated medically, and 3 dogs were euthanatized without treatment. Surgical treatment consisted of cholecystectomy in 11 dogs, choledochotomy in 5 dogs, cholecystotomy in 4 dogs, and cholecystojejunostomy in 1 dog. Sphincter of Oddiotomy was performed in 1 dog. Five dogs had concurrent generalized peritonitis attributable to bile. Multiple choleliths were detected in most of the dogs. Choleliths were located in the gallbladder in 20 dogs and in the bile ducts in 14 dogs. The most common abnormalities of the gallbladder, identified histologically, were chronic cholecystitis, mucosal hyperplasia, and pericholecystic inflammation. The most common abnormalities of the liver were cholestasis, hepatocellular degeneration, and periportal fibrosis. Survival rate of dogs that underwent cholecystectomy tended to be higher (86%) than that of dogs treated via cholecystotomy (50%) or cholecystectomy in combination with choledochotomy (33%). Dogs that underwent medical treatment, abdominal exploratory, cholecystojenunostomy, choledochotomy, and sphincter of Oddiotomy died or were euthanatized because of redevelopment of clinical signs associated with cholelithiasis.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Incidence of cholelithiasis in India.

Incidence of cholelithiasis in the teaching hospital population of India has been reported. The study suggests that North Indians are more prone to cholelithiasis than South Indians. Apparently this variation is related to dietary and geographical factors.

Adolescent↗

Cholelithiasis in Dar es Salaam, Tanzania.

In a five year review, there were 30 cases of cholelithiasis treated at the Muhimbili Medical Centre, Dar es Salaam, Tanzania. The male to female ratio was 1:3, and the peak age for cholelithiasis was in the 30 to 49 years age group. Right upper quadrant abdominal pain was the commonest presenting symptom (100 pc), and cholecystectomy was performed in all patients. Local complications of gall stones were recorded in seven patients (23.3 pc) and these included; gall bladder empyema, pericholecysteal abscess, CBD stone, gall bladder adenoma, gall bladder mucocele, and two patients had acute cholecystis. Stones were multiple in 90 pc of patients, and on macroscopic classification the ratio of cholesterol to pigment stones was 2:1. There was no death in this series of 30 patients.

Adult↗

Predicting the presence of choledocholithiasis in patients with symptomatic cholelithiasis.

OBJECTIVES: Accurate preoperative prediction of choledocholithiasis is essential in order to minimize patient risk and curtail health care expenditures. This study was designed to identify independent risk factors for choledocholithiasis in patients who had undergone cholecystectomy for symptomatic cholelithiasis and to develop a predictive model based on those factors. METHODS: The charts of 1264 consecutive patients who had undergone cholecystectomy at one of three North Carolina hospitals between January 1, 1989 and December 31, 1991 were reviewed; 465 of these patients had confirmed presence or absence of choledocholithiasis by cholangiography and/or common bile duct exploration and were eligible for analysis. Candidate predictor variables included age and maximum preoperative values for each of the following: temperature, alkaline phosphatase, bilirubin, AST, amylase, white blood cell count, and common bile duct diameter. Model development and validation were conducted using standard data-splitting (60% "training," 40% "test") and logistic regression techniques. RESULTS: Choledocholithiasis was confirmed in 115 (25%) of the 465 eligible patients. Univariate analysis identified bilirubin, common bile duct diameter, AST, temperature, alkaline phosphatase, and age as predictors. Multivariable analysis subsequently identified bilirubin, common bile duct diameter, AST, alkaline phosphatase, and age as independent predictors of choledocholithiasis. A final model containing these variables (except age, whose contribution to the model was small) accurately predicted choledocholithiasis (c-index = 0.76). CONCLUSIONS: Accurate estimates of choledocholithiasis risk can be made using maximum preoperative bilirubin, common bile duct diameter, AST, and alkaline phosphatase values. Use of the model may help physicians select those patients with symptomatic cholelithiasis who would most likely benefit from further investigation to exclude choledocholithiasis.

Case-Control Studies↗

[Occupational-social influence in the course of cholelithiasis].

The aim of the study was to examine the relationship between the work load, evaluated by the occupational activity, and the incidence of cholelithiasis. In total 372 subjects (169 cholelithiasis patients examined using USG, and 203 controls), hospitalised in 1993 in the Department of Gastroenterology, Regional Hospital, Białystok, completed the questionnaire. Attention was also given to age, sex, permanent residence, education and physical activities after work. A moderate physical effort, both occupational and non-occupational, seemed to reduce the risk of cholelithasis.

Chi-Square Distribution↗

[Cholelithiasis in children and adolescents (authors transl)].

Cholelithiasis is a rare, but important condition to be considered in the differential diagnosis of abdominal symptoms in childhood and adolescence. A survey over a 20-year period revealed 10 cases between the ages of 11 and 20 years, with a clinical history of cholelithiasis of between 5 days and 6 years. The most consistent finding was epigastric or right upper quadrant pain. Serum chemistry did not contribute conclusively towards the diagnosis. Hereditary spherocytosis was demonstrated in 3 cases, 2 had familial gall bladder disease, whilst in the rest no cause could be found. Two patients are described in some detail: one girl with spherocytosis and a bilirubin of 78 mg/100 ml, presenting with choledochal obstruction and pancreatitis, and another girl with a history of recurrent abdominal pain, negative radiologial and chemical pathological findings and a tentative diagnosis of neurosis. Oral cholecystograms lead to the diagnosis in most cases; however i. v. cholangiograms should be considered whenever the diagnosis appears in doubt. All cases were treated by cholecystectomy and recovery was uneventful in 9 patients. Cholecystectomy should be performed in all patients with gall stones, even in the absence of symptoms.

Adolescent↗

[A new theoretical and experimental validation of the treatment and prevention of cholelithiasis].

Approaches are proposed, new in principle, toward breaking biliary calculi into pieces, as well as toward prophylaxis of cholelithiasis. Exposure of the concrements to ultrasound with varying resonance frequency in a contact medium containing litholytic substances permits bringing about their reduction to fragments being safe for their evacuation from the biliary system. Prevention of cholelithiasis involves identification of precalculous period and exposure of the gallbladder region to vibration along with adopting conventional therapy.

Bile↗

[Clinical and experimental study of danfukang granule in treating cholecystitis and cholelithiasis].

In order to evaluate the clinical effect of Danfukang Granule (DFKG) in treating cholecystitis and cholelithiasis, 200 patients were treated with DFKG and observed with ultrasonography before and after treatment. Results showed 48 cases (24%) among the 200 patients were cured, 76 (38%) were marked effective, 70(35%) were improved and 6 (3%) ineffective, the effective rate being 97%. The lithagogue rate of cholelithiasis patients with diameter of gallstone < 0.5 cm, or those with sandy stone was 62%. In 50 post-operative patients received DFKG treatment, 28 (56%) were cured, 18 (36%) marked effective, 2 (4%) improved and 2 (4%) were ineffective, the total effective rate being 96%, while in the other 50 cases did not receive DFKG, the numbers were 8 (16%), 12(24%), 15 (30%), 15 (30%) and 70% respectively. The difference of total effective rate between the two groups were significant (analyzed by chi 2 test, P < 0.05). Experimental study-showed that the flow of hepatic bile in experimental group of guinea-pig was 3.7 +/- 0.4 ml/h, which was significantly higher than that of control group (2.7 +/- 0.1 ml/h), P < 0.05. The bile stone formation rate in experimental group was 32.4%, which was markedly lower than that of control group (93.8%), P < 0.01, suggesting the bile stone formed in experimental guinea-pigs could be evacuated by the rinsing effect of DFKG.

Adult↗

High prevalence of cholelithiasis in a low income Mexican population: an ultrasonographic survey.

The authors present the results of a population-based survey of cholelithiasis carried out in a low-income area of Mexico City using high-resolution gallbladder ultrasound. The purpose of the study was to estimate the prevalence and selected associated risk factors of cholelithiasis (CL). The population of the studied area was 15,532 subjects, of whom 3,505 (22.6%) were eligible for the baseline survey (men and non-pregnant women between 35-64 years of age). Of this group, 1,735 (76.03%, 702 men and 1,033 women) were located for a follow-up study. Ultrasonography was performed on all except for 100 subjects who had undergone previous cholecystectomy. Crude prevalence of CL was 14.1% (95% CI 12.5-15.5). The prevalence was 5.8% (95% CI 4.1-7.5) in men and 19.7% (95% CI 17.3-22.1) in women. Presence of gallstones was associated with age, sex (men p<0.006, women p<0.001), and multiparity (p<0.002). Centrality index in men and body mass index in women were positive and significantly associated with CL when compared with subjects without CL. High levels of fasting and post-glucose load insulin in women and men respectively were associated with CL. The authors conclude that the population of this study has a high prevalence of CL and confirm some known risk factors such as age, sex, BMI and multiparity. Proper assessment of the magnitude problem and characterization of potentially modifiable risk factors will play a major role in preventing this pathology.

Adult↗