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[Cholelithiasis following gastric surgery].

A retrospective study was carried out in order to verify the correlation between the biliary disease and previous gastroduodenal operations for various lesions. The 24 patients (18 males and 6 females with an average age of 54 years) reported were diagnosed with chronic or acute cholelithiasis (with common bile duct stones and cholangitis) which imposed emergency or short delayed surgery in most of the cases. The previous gastric operations performed 5 up to 23 years ago were classic gastrectomies with Polya (9 cases) or Péan (8 cases) anastomosis, truncal vagotomy with pyloroplasty or gastroenterostomy for gastric and duodenal ulcers, one hemigastrectomy, one antrectomy and one tumorectomy for benign gastric tumours (one schwannoma and two polyps), one enlarged subtotal gastrectomy for adenocarcinoma and, finally, one gastrotomy for a suspected bleeding gastric tumour. The causal connection between cholelithiasis and previous gastric surgery is obvious, anatomical changes and alterations in the kinetics of the duodenum and common duct being incriminated.

Adult↗

PubMed1998

Cholelithiasis in young Saudi women.

We studied some of the factors associated with gallstones in a sub population of Saudi women who presented with cholelithiasis at a rather young age, 17-30 years. We determined the weight, height, ideal weight, overweight, Quetelet index, ideal Quetelet index, and parity in 152 such women designated the study group and in another aged matched group of 152 women without biliary disease designated the control group. Although the mean weights of both groups were greater than ideal, the mean weight, level of overweight, and mean Quetelet index in the study group were greater than those of the controls at virtually all age groups (p > 0.001). In the study group, comparison of the 17-25 year olds with the 26-30 year olds showed close similarity in weight, Q index, and level of overweight (p = 0.50). There was no significant difference in parity between the study group and the controls. We conclude that obesity is a significant factor in the development of cholelithiasis in Saudi women who develop symptomatic gallstones in the age group 17-30 years.

Adolescent↗

PubMed1998

Clinical and laboratory predictors of cholelithiasis in patients with sickle cell anaemia.

Cholelithiasis is a common clinical condition in patients with sickle cell disease and there are conflicting reports on laboratory indices useful in predicting those patients who are likely to have gallstones. There is however lack of similar studies from Kenya. We therefore studied the role of clinical (Body Mass Index), haematological (reticulocyte count, haemoglobin level), and biochemical (serum bilirubin: direct and indirect, serum alkaline phosphatase, serum transaminase) indices in predicting sickle cell anaemia patients likely to develop gallstones. A cross sectional descriptive study was conducted from October 1993 to December 1994 on consecutive male and female patients of all ages with homozygous sickle cell disease (HbSS) confirmed by cellulose acetate paper electrophoresis. A total of 64 patients aged between three and 37 years were recruited into the study. They were classified into two groups: stone formers and non-formers. The difference in the two groups with respect to clinical, haematological and biochemical indices were determined by Chi-square contingency test. Body mass index (BMI), reticulocyte count and alkaline phosphatase were found to have a significant positive association with increased likelihood of gallstone formation at p values of 0.004, 0.007 and 0.007, respectively. The rest of the study indices had no association. The cut-off points were reticulocyte counts above ten per cent and alkaline phosphatase levels above 13 K.A. units. Though sickle cell anaemia patients with BMI > 20 had significant increased likelihood of cholelithiasis, we could not determine its cut-off value.

Adolescent↗

PubMed1976

[Results of treatment of cholelithiasis and its consequences; the so called "postcholecystectomy-syndrome" (author's transl)].

Our analysis of 378 patients made after operations for diseases of the gallbladder and bile tract underlines the demand of an exact preoperative diagnostic examination of other abdominal organs, e.g. the oesophagus, stomach, duodenum, liver and pancreas. The value of using modern intraoperative diagnostic procedures for the biliary tract is confirmed. Our analysis also demonstrates the necessity of traeting cholelithiasis surgically at an early stage. Complications of cholelithiasis include a higher risk, a worse prognosis with regard to permanent healing and a higher rate of postoperative lethality.

Bile Ducts↗

PubMed2006

Case report of symptomatic cholelithiasis after ventricular cholecystic shunt.

Hydrocephalus is a prevalent problem in the pediatric population, and patients with ventriculo-peritoneal shunts are often encountered. The use of ventricular cholecystic shunts is an option for patients who are unable to have a ventriculo-peritoneal shunt. This is a case report that describes a late complication of a ventricular cholecystic shunt. Eleven years after insertion of a ventricular cholecystic shunt, the patient developed cholelithiasis encrusted on shunt tubing. The shunt was revised, and 6 months follow-up has shown relief of symptoms and no further evidence of cholelithiasis.

Adolescent↗

PubMed2002

The Syrian golden hamster strain LPN: a useful animal model for human cholelithiasis.

The purpose of this study was to specify the main mechanisms at the origin of gallstone formation in very young (5-week old) or young adult (9-week old) LPN hamsters fed a sucrose-rich (normal lipid) lithogenic diet for one and four weeks, respectively. It was also to compare these mechanisms in the two strains of hamsters (LPN and Janvier) or when an anti-lithiasic diet was given by substituting 10% of the sucrose by beta cyclodextrin. The LPN strain of hamsters showed a very high incidence of cholesterol gallstones (73%) after receiving the lithogenic diet. The gallstone formation is very rapid and occurs in less than one week in very young hamsters which show a high cholesterol synthesis rate in the liver. The cholesterol and phospholipid concentrations in the bile, cholesterol saturation index (CSI) and hydrophobic index (HI) increased significantly, concomitantly with a higher liver cholesterol synthesis in very young hamsters and with a lower bile acid synthesis (neutral pathway: cholesterol 7alpha-hydroxylase, CYP7A1 and acidic pathway: sterol 27 hydroxylase, CYP27A1) in young adult hamsters. No significant changes in the lipoprotein receptor expression (LDLr, SR-BI) were observed after feeding the lithogenic diet. Adding ten per cent beta-cyclodextrin, a cyclic oligosaccharide that binds cholesterol and bile acids to the lithogenic diet at the expense of sucrose, induced a decrease in cholesterol bile secretion and in the CSI and HI and prevented cholesterol gallstone formation. Similarly, another strain of Syrian Golden hamsters (" Janvier ") which originally exhibited a smaller bile cholesterol concentration, lower liver cholesterol synthesis and higher CYP7A1/CYP27A1 activity ratio did not carry cholesterol gallstones when fed the lithogenic diet. The main parameters always found at the origin of cholelithiasis in the Hamster are discussed: a higher hepatic cholesterogenesis (HMGCoAR), a higher HMGCoAR/CYP7A1 activity ratio, a lower cholesterol ester storage capacity, a higher CYP27A1/CYP7A1 activity ratio correlated to a higher cholesterol secretion in the bile and higher CSI and HI. In LPN hamsters, the incidence of cholesterol gallstones is nil when CSI + HI < 0.8 and positive for CSI + HI > 0.9. An overall comparison of the data obtained in LPN Hamsters and in Man suggests that this hamster strain appears to be an interesting model for human cholelithiasis.

Journal Article↗

PubMed2001

[Clinical and pathogenetic significance of biliary tract abnormalities in a child with cholelithiasis].

The clinical peculiarities of cholelithiasis in the children with biliary tract's anomalities are presented in this paper. The data of clinical, instrumental examinations and anamnesis are analysed. Although, there are some clinical peculiarities of cholelithiasis in the patients with biliary tract's anomalities, intrascopic methods of examination are preferable. Ultrasonography is used as quick method during before hospital examination. Retrogdade cholangiopancreatography in special hospital is the main diagnostic method in such patients, that defines the date, volume and kind of operation.

Adolescent↗

PubMed2000

Cholelithiasis: genetic hypothesis.

In inbred mice gallstone susceptibility is determined by Lith (lithogenic) genes which promote cholesterol hypersecretion in bile as a response to a high-fat diet. At least three major classes of proteins can be considered as candidate genes: (a) enzymes involved in cholesterol metabolism regulation; (b) trans-membrane carrier proteins from hepatocyte into bile; (c) cytosolic transfer proteins which regulate intrahepatocyte trafficking. The main candidates are: Spgp, a transmembrane protein which produces bile salt transport. Its gene map in Lith 1 region (Chromosome 2) and its expression is increased in susceptible inbred strains of mice (C57L) of inbred mice. Cmoat is a carrier protein that promotes the secretion of conjugated substances in bile. Its gene map in Lith 2 region (Chromosome 19) and its expression is increased in susceptible inbred strains of mice fed on a lithogenic diet. HGMR is the enzyme that regulates de novo synthesis of cholesterol in the liver. Its activity increases in resistant strains fed on a lithogenic diet and unvaries in susceptible strains. Its gene does not reside in any Lith region, but one Lith gene could be responsible for its activity regulation. To date, the hypothesis of a genetic basis of cholelithiasis in men has only been investigated in one study, in which the association of cholelithiasis and a mutation in the C7AH gene was documented in a group of Mexican patients.

Journal Article↗

PubMed1990

[Plasma levels of various gastrointestinal polypeptides in patients with cholelithiasis and different degree of functional disorders of the major duodenal papilla].

Findings of dynamic cholangiomanometry with the analysis of the tension curves are overviewed. This technique helped reveal different functional ailments of the bile papilla in major variants of the cholelithiasis course (acute obstructive++ cholecystitis, recurrent pancreatitis, and choledocholythiasis with obstructive jaundice). Parallel radioimmunoassay-based studies of a series of gastrointestinal polypeptides (insulin, glucagon, gastrin, vasoactive peptide, bombesin , and somatostatin) were conducted to determine the importance of these polypeptides in the pathogenesis of cholelithiasis complications. The levels of certain polypeptides were found to be related to the clinical manifestations of the disease. The complex assessment of the bile papilla function and gastrointestinal polypeptide concentrations offers a possibility for elaborating the pathogenetically relevant methods of therapy for this group of diseases.

Adult↗

PubMed1963

ORNITHOCHOLANIC ACIDS AND CHOLELITHIASIS IN MAN.

Ornithocholanic acids and small soft gall stones were found in the bile of patients from which Klebsiella pneumoniae was also isolated. Cholelithiasis may be initiated by metabolic disturbances in the conjugation of bile acids in liver tissue and the subsequent precipitation of cholesterol and bile pigment.

Bile↗

PubMed1980

Sonographic diagnosis of cholelithiasis in childhood.

With the development of new gray scale signal processing, a high level of accuracy has been obtained with gallbladder sonography. Biliary calculi seem to be more prevalent in the pediatric population than is generally appreciated. Two interesting features of childhood cholelithiasis are the increased incidence in patients without hemolytic anemia and the uncommonly high percentage of gallstones visible with plain roentgenograms of the abdomen. Cholecystosonography is offered as an additional method of establishing diagnostic certainty.

Child↗

PubMed1988

Cholecystectomy and cholelithiasis in sickle cell anemia.

Elective cholecystectomy was performed on 12 children (eight male and four female; age range, 4 to 19 years; and mean age, 11.2 years) with abdominal pain that was related to gallstones. Seven patients had jaundice, six had nausea, five had fat intolerance, and three had biliary colic. Two simple transfusions (10 mL/kg of packed red blood cells), designed to decrease the hemoglobin S content to less than 30% and to increase the total hemoglobin level to greater than 100 g/L, were given preoperatively two to three weeks apart. A third transfusion was given on the day before surgery if the total hemoglobin level was less than 100 g/L. The preoperative mean hemoglobin S content was decreased from 88% to 31%, and the mean total hemoglobin level was raised to 122 g/L. There were no preoperative or intraoperative complications. Post-operatively, no patients developed complications that were related to sickle cell anemia. Hospitalization averaged 6.3 days. Recurrent abdominal pain resolved shortly after surgery in all patients. With proper preoperative transfusions, elective cholecystectomy is safe in children with sickle cell anemia. Elective cholecystectomy should be recommended at the time of diagnosis of cholelithiasis.

Adolescent↗

PubMed1975

Biliobiliary fistula. A trap in the surgery of cholelithiasis.

Of 24 cases of abnormal communication between gallbladder and main bile duct occurring in a service specializing in hepatobiliary surgery, jaundice was present in all, but variable in degree and persistence. No particular clinical picture suggested this complication of cholelithiasis, and preoperative diagnosis is rare. At operation, adhesions were strikingly dense, often first suggesting a diagnosis of cancer. The gallbladder, fused to the main bile duct, should not be dissected from it because of the risk of ductal injury. Under these conditions, the gallbladder should be opened peripherally, stones extracted, and a cholangiogram performed to assess the situation. Treatment consists of partial cholecystectomy and closure of a cuff of gallbladder wall over a T tube placed into the main bile duct through the fistula.

Adult↗

PubMed1980

Cholelithiasis and cholecystitis in children after repair of congenital duodenal anomalies.

Duodenal surgery, particularly the correction of duodenal anomalies, may be associated with an increased incidence of subsequent cholelithiasis and cholecystitis in children. We review the case histories of two children. Each child experienced acute cholecystitis with gallstones nine years after the correction of duodenal anomalies (annular pancreas, duodenal stenosis) in the neonatal period. At reoperation, intense fibrosis was noted in the hepatoduodenal area, while cholangiography demonstrated abnormalities of the common hepatic and common bile ducts. These cases suggest that the correction of duodenal anomalies may favor the subsequent development of gallstones in children. Fibrosis may have compressed the common bile duct, with stasis permitting gallstone formation. Intrinsic bile duct abnormalities, which may accompany duodenal anomalies, could also play a role. Thus, a history of previous duodenal surgery in a child with abdominal pain may strengthen a tentative diagnosis of cholecystitis. Also, at the time of exploration, the surgeon should be alert to the possibility of biliary tract abnormalities.

Acute Disease↗

PubMed1983

Endoscopic retrograde cholangiopancreatography. Diagnosis of cholelithiasis in patients with normal gallbladder x-ray and ultrasound studies.

The combination of a normal oral cholecystogram and ultrasound study of the gallbladder is considered adequate evidence to exclude cholelithiasis as a cause of biliarylike pain. We examined 206 patients with biliarylike pain and normal findings on cholecystogram and ultrasound study of the gallbladder by endoscopic retrograde cholangiopancreatography (ERCP). Of the 195 patients who had successful ERCP, 32 patients (group 1) had mild, transient abnormalities in liver function tests and 163 (group 2) had normal liver function test results. Small gallstones were demonstrated on ERCP examination in 25 of 32 group 1 patients and in four of 163 group 2 patients, all confirmed at surgery or endoscopic sphincterotomy. In conclusion, despite negative results on cholecystogram and ultrasound study of the gallbladder, patients with biliarylike pain and abnormal liver function test results should be evaluated further by diagnostic ERCP examination.

Amylases↗

PubMed1997

Ground squirrel model for cholelithiasis: role of epithelial glycoproteins.

The cholesterol-fed Richardson's ground squirrel (Spermophilus richardsonii) has proven to be an effective animal model in which to study factors that influence cholesterol gallstone formation and associated alterations in the gallbladder epithelium. Ground squirrels of either sex, fed a 2% cholesterol-enriched diet, exhibit cholesterol monohydrate crystal precipitation within 24 hours and macroscopically visible cholesterol stones by 3 weeks. Data on bile chemistry, biliary cholesterol precipitation, and various mucosal alterations occurring prior to, during, and after stone formation were collected using sampling intervals from 6 hours to 20 weeks on the diet. The results indicate that mucin hypersecretion appears to be more closely related to the initiation of nucleation than does either bile calcium of pH. Mucus hypersecretion begins within 18 hours of diet initiation and continues throughout the 20 week experimental period. Apical excrescences became more common and were larger in size during the early stages of cholelithiasis. Administration of aspirin during the experimental period demonstrated an inhibition of mucin synthesis and release. Gallstones were not formed in these aspirin-treated animals. A lectin-binding panel for 10 epithelial glycoprotein-related sugars indicated the mucin secreted by the gallbladder epithelium of 7 day experimental animals differed from that of controls. The most obvious difference was the abolition of WGA binding in the experimental animals, suggesting an absence of sialic acid expression in the mucin during the lithogenic process. Ultrastructural histochemistry indicated that both sulphomucin and sialomucin were present in the secretory granules and within the surface mucus layer of both experimental and control animals. Experimental animals, however, exhibited a significant predominance for sulphomucin. This pattern varies from that typically seen in other regions of the gastrointestinal tract where sialomucins predominate during pathologic processes.

Animal Feed↗

PubMed1992

Giant cell tumor-like cholangiocarcinoma associated with systemic cholelithiasis.

A cholangiocarcinoma of the hepatic hilus with an element of giant cell tumor that occurred in a 59-year-old man is reported. His medical history included systemic cholelithiasis and repeated operations on the biliary passages. Four years after the last operation, which was a hepatic segmentectomy, he was readmitted because of persistent fever. A computed tomography scan showed a low-density area and stones in the hepatic hilus. He died of hepatic failure approximately 1 month later. At autopsy, a fist-sized tumor and gallstones were found at the hepatic hilus. Histologically, the tumor mainly showed sarcomatoid features and some tubular adenocarcinoma. An element of giant cell tumor consisting of many osteoclast-type giant cells also was noted. The results of immunohistochemical studies showed a positive reaction to cytokeratin and vimentin in some of the spindle-shaped sarcomatoid cells. Sarcomatoid bile duct carcinomas are rare, as are those with osteoclast-type giant cells. The authors also discuss the histogenesis of these giant cells.

Adenoma, Bile Duct↗

PubMed1987

Relative contribution of bile and pancreatic juice duodenogastric reflux in gastric ulcer disease and cholelithiasis.

Bile acid concentrations, phospholipase A2 activity and pH in the stomach were measured in the fasting state and for 2 h after a fat-containing test meal in patients with an active gastric ulcer (GU), in patients with gallstones before and after cholecystectomy and in normal subjects. Fasting and peak postprandial bile acid concentrations in the stomach were low in all normal controls. Although high concentrations were found in many patients with GU (P less than 0.01), similar concentrations were found in many patients with radiologically non-functioning gallbladders containing gallstones (NFG) (P less than 0.01) and also after cholecystectomy (AC) (P less than 0.01). Fasting intragastric phospholipase A2 activities were similar, and very high in GU and NFG patients compared with control subjects (P less than 0.01). High values were not found after cholecystectomy. There was no difference in pH profile or in postprandial phospholipase A2 between patient groups. Since patients with cholelithiasis or after cholecystectomy are not known to have an increased incidence of gastric ulceration, the significance of duodenogastric reflux in the aetiology of gastric ulcers must be questioned. If reflux does produce ulcers in GU patients then factors in addition to bile acid are probably involved. However, neither patterns of phospholipase A2 reflux nor pH profiles can explain the absence of gastric ulceration in those patients with gallstones who reflux large quantities of bile acid.

Adult↗