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PubMedDate not supplied

Double gallbladder originating from left hepatic duct: a case report and review of literature.

BACKGROUND: Double gallbladder is a rare anomaly of the biliary tract. Double gallbladder arising from the left hepatic duct was previously reported only once in the literature. CASE REPORT: A case of symptomatic cholelithiasis in a double gallbladder, diagnosed on preoperative ultrasound, computed tomography (CT) and endoscopic retrograde cholangiopancreatogram (ERCP) is reported. At laparoscopic cholangiography via the accessory gallbladder no accessory cystic duct was visualized. After conversion to open cholecystectomy, the duplicated gallbladder was found to arise directly from the left hepatic duct; it was resected and the duct repaired. CONCLUSIONS: We emphasize that a careful intraoperative cholangiographic evaluation of the accessory gallbladder is mandatory in order to prevent inadvertent injury to bile ducts, since a large variety of ductal abnormality may exist.

Aged↗

PubMed1999

[Effect of prokinetic drugs inhibiting dopaminergic system on gallbladder motility in subjects with duodenal ulcer].

The purpose of this study was to determine the effect prokinetic drugs inhibiting dopaminergic receptors on gallbladder volume in normal conditions. The study comprised 90 males, aged 20-26 years with duodenal ulcer disease in remission alloted into 3 groups, 30 subject each. The gallbladder volume was determined in group I after placebo or 10 and 20 mg or metoclopramide administration; in group II: placebo or 10 and 20 mg of domperidone and in group III after placebo or 50 and 100 mg of sulphiride administration. Gallbladder motility was assessed ultrasonographically from 15 minutes to 2 hours since placebo or drug administration. The effect of the studied prokinetic drugs in fasting on gallbladder motility was differentiated after metoclopramide no significant changes in gallbladder volume were observed; after domperidone in the dose of 20 mg a slight decrease of gallbladder volume was found, whereas after sulphiryde statistically significant decrease was detected.

Adult↗

PubMedDate not supplied

Epidemiology of gallbladder cancer.

Gallbladder cancer, although rare in most Caucasian populations, is among the most frequently observed cancers in native populations of North and South America, and in the Maori population of New Zealand. In all populations, there is a strong correlation between gallstones and gallbladder cancer: the risk of gallbladder cancer is approximately 4-5 times higher in patients with gallstones, than in patients without gallstones. In those populations where the onset of gallstone disease occurs in the first few decades, the risk is much higher. Obesity, which is also a risk factor for gallstones, increases the risk of gallbladder cancer, as does the consumption of diets high in fats and calories. Other risk factors, such as increased parity, also increase the frequency of gallbladder cancer, most probably explained by the association between gallstones and parity. Prophylactic cholecystectomy for asymptomatic gallstones cannot be justified for the control of gallbladder cancer, but the increasing frequency of this procedure in many countries, secondary to the widespread use of laparoscopic surgical techniques, will clearly lower the incidence and mortality rates for this lethal disease.

Adult↗

PubMed1999

Sequential sonographic changes of the gallbladder in hemobilia: case report of a patient with intrahepatic duct stones.

The sonographic features of hemobilia in the gallbladder have been reported with variation, including an echogenic mass, hypoechoic mass, and scattered intraluminal echoes. The sequential sonographic changes of hemobilia in the gallbladder were observed in a 59-year-old male patient with bilateral intrahepatic duct stones. The sonograms of hemobilia in the distended gallbladder initially showed a hyperechoic, homogeneous, movable mass-like lesion, 36 hours before the onset of upper gastrointestinal (UGI) bleeding. A hypoechoic mass-like lesion with a hyperechoic ring was found 5 days after the onset of UGI bleeding. A faint hypoechoic mass-like lesion was found 7 days after the onset of UGI bleeding (the day of no further bleeding). Scattered echoic densities were found 9 days after the onset of UGI bleeding, then disappearance of the lesion was noted 12 days after the onset of UGI bleeding. The sonographic patterns of hemobilia in the gallbladder vary depending on the timing of lysis of the blood clot. It should be differentiated from gallbladder cancer, a stone, a polyp, sludge, acute gangrenous cholecystitis, and gallbladder empyema.

Bile Ducts, Intrahepatic↗

PubMedDate not supplied

Gallbladder adenomyomatosis presenting as fever of unknown origin: a case report.

Gallbladder adenomyomatosis is a rare disorder, characterized by benign hyperplasia of the gallbladder mucosa creating invaginations through the muscular layer, known as Rokitansky-Aschoff sinuses. It is considered an acquired disease, with pathophysiology similar to that of the diverticular disease of the colon. Diagnosis is often achieved by ultrasound, but a significant percentage is misdiagnosed as chronic cholecystitis, whereas the diagnosis is finally achieved histologically. We describe a case of gallbladder adenomyomatosis presenting as fever of unknown origin. The patient was a 17-year-old girl with a history of sustained fever of 38.5 degrees C of two months' duration. There were no accompanying symptoms and the whole diagnostic workup, including abdominal ultrasound, was negative. Gallbladder inflammation was evident during an eventual investigatory laparoscopy, and cholecystectomy was performed. The histologic results were consistent with diffuse adenomyomatosis. The patient became afebrile immediately after cholecystectomy. To our knowledge, fever has never been associated with gallbladder adenomyomatosis before in bibliography, nor has adenomyomatosis been mentioned as a cause of fever of unknown origin. We therefore believe that gallbladder adenomyomatosis should be considered in the differential diagnosis of sustained fever with negative workup.

Adenomyoma↗

PubMed2001

Ultrasonography incorrectly diagnoses gallbladder polyps.

To determine the accuracy of ultrasound-diagnosed polypoid lesions of the gallbladder in their institution, the authors reviewed the records of 41 patients with polypoid lesions of the gallbladder who underwent cholecystectomy, and collected data concerning age, sex, symptoms, and histopathologic diagnosis. Histopathologic evaluation confirmed polyps in only two patients (4.9%) categorized as having polypoid lesions of the gallbladder. Most specimens from patients with ultrasonography reports suggesting small polyps manifested cholesterolosis (17 of 41) or cholelithiasis (15 of 41). No specimen harbored malignancy. Mean patient age was 47.4 years, and the most common symptoms were pain (85%), nausea (44%), vomiting (29%), and abnormal liver function test results (14%). The accuracy of sonography for diagnosing polypoid lesions of the gallbladder was poor. Many of the small polyps seen on sonography most likely represented a stone embedded in the gallbladder wall or other abnormality. Because of the likelihood of cholelithiasis, the authors recommend that patients with biliary symptoms and ultrasonography findings suggesting polypoid lesions of the gallbladder undergo cholecystectomy.

Adult↗

PubMed2001

Expression of MUC1 mucins in the subserosal layer correlates with postsurgical prognosis of pathological tumor stage 2 carcinoma of the gallbladder.

The overall outcome of pT(2) gallbladder carcinoma has not been favorable. Postsurgical recurrence at distant sites occurs in some cases, although the carcinoma was limited to the gallbladder wall. A high level expression of MUC1 mucins with sialylated carbohydrates (sialylated MUC1 mucins) is correlated with poor survival in intrahepatic bile duct carcinoma. In the present study, immunohistochemistry was performed to determine the expression level of sialylated MUC1 mucins, detected by a monoclonal antibody, MY.1E12, in 31 cases of pT(2) gallbladder carcinoma on which curative resections had been performed and to determine the correlation of the expression level of MY.1E12-reactive-MUC1 mucin with mode of recurrence and postsurgical survival. Immunostainings of the MUC1 mucin were recognized in different types of noncancerous pathological epithelia of the gallbladder except for intestinal metaplasia and cancerous epithelia. Immunohistochemical localization was classified into apical, cytoplasmic, and stromal types based on the predominant cellular distribution of MY.1E12-reactive-MUC1 mucin. In 31 cases of pT(2) carcinoma, the localization was apical type in 64%, cytoplasmic type in 71%, and stromal type in 48% of the cases at the deepest invading sites in the subserosal layer. Distant recurrences, i.e., peritoneal dissemination in 8 patients and liver metastasis in 3 patients, were seen in 8 (53%) of 15 cases of pT(2) carcinoma that had > or =10% of the cancerous epithelia showing stromal localization of the MUC1 mucin at the deepest invading sites and in 2 (12%) of 16 cases that had <10% of those showing the stromal localization. The postsurgical survival outcome was significantly poorer in the former than in the latter (P = 0.044). In pT(2) gallbladder carcinoma, the presence of MY.1E12-reactive-MUC1 mucin in the stroma adjacent to the cancerous epithelia in the subserosal layer correlates with the aggressiveness of the disease, such as the tendency to form distant recurrences. This phenotype may serve as a unique biological feature associated with the malignant behavior of pT(2) gallbladder carcinoma.

Aged↗

PubMedDate not supplied

Anomalous pancreaticobiliary ductal junction without bile duct dilatation in gallbladder cancer.

BACKGROUND/AIMS: Anomalous pancreaticobiliary junction is a rare anomaly but is a risk factor for primary carcinoma of the gallbladder. To define the relationship between anomalous pancreaticobiliary junction, especially if it is not associated with common bile duct dilatation, and gallbladder carcinoma, we retrospectively reviewed data of 126 patients with gallbladder carcinoma. METHODOLOGY: All these patients had undergone direct cholangiography either by endoscopic retrograde cholangiopancreaticography or percutaneous transhepatic cholangiography. RESULTS: Among 126 patients with gallbladder cancer, 23 patients (18.3%) exhibited anomalous pancreaticobiliary junction. Patients with anomalous pancreaticobiliary junction were younger (mean age: 54 +/- 9.1 years) than patients without anomalous pancreaticobiliary junction (mean age: 65 +/- 9.7 years). The incidence of gallstones in patients with anomalous pancreaticobiliary junction (17%) was significantly lower than in those without this anomaly (64%) (P < 0.01). Among the 23 patients with anomalous pancreaticobiliary junction, 12 patients (52%) had no bile duct dilatation and, 11 patients (48%) had bile duct dilatation in the form of fusiform or cylindrical dilatation. However, no cases with severe cystic dilatation were found. Patients of anomalous pancreaticobiliary junction without common bile duct dilatation had more advanced disease and poor prognosis than those with common bile duct dilatation. CONCLUSIONS: The present study revealed that gallbladder cancer in the patients of anomalous pancreaticobiliary junction without common bile duct dilatation was diagnosed at advanced stage and the prognosis was very poor. Therefore, if a minor abnormality is detected in the wall of acalculous gallbladder on ultrasonography, direct cholangiography should be done to exclude this anomaly.

Adult↗

PubMedDate not supplied

Evidence of gallbladder function changes in hepatoma after transcatheter arterial embolization by quantitative Tc-99m DISIDA cholescintigraphy.

BACKGROUND/AIMS: Transcatheter arterial embolization is the treatment of choice for inoperable hepatocellular carcinoma. Gallbladder infarction following transcatheter arterial embolization has been reported, therefore, the gallbladder functions were studied using the quantitative Tc-99m DISIDA cholescintigraphy in the present study. METHODOLOGY: The gallbladder functions which were presented as the filling fraction and the ejection fraction in 24 patients with hepatoma before and after transcatheter arterial embolization. The patients were separated into two groups. Group 1: 12 patients received precystic artery transcatheter arterial embolization and group 2: 12 patients received postcystic artery transcatheter arterial embolization. RESULTS: After transcatheter arterial embolization, significantly decreased both gallbladder functions of filling fraction (61.2 +/- 7.4% and 48.3 +/- 6.5%) and ejection fraction (47.8 +/- 6.0% and 36.5 +/- 5.3%) were found in group 1 patients. However, no significant change of filling fraction (59.0 +/- 5.0% and 58.8 +/- 7.4%) and ejection fraction (49.9 +/- 2.4% and 49.3 +/- 5.7%) in group 2 patients. CONCLUSIONS: Impaired gallbladder functions were common in hepatoma patients who received precystic artery transcatheter arterial embolization, and Tc-99m DISIDA cholescintigraphy may be useful for evaluating the gallbladder functions in hepatoma patients who received transcatheter arterial embolization.

Carcinoma, Hepatocellular↗

PubMed2001

[Incipient gallbladder carcinoma. Clinical and pathological study and prognosis in 196 cases].

BACKGROUND: There is little information about the behavior of early gallbladder carcinoma. AIM: To report the clinical and pathological features of 196 patients with early gallbladder carcinoma. MATERIAL AND METHODS: All patients with gallbladder cancer diagnosed between 1988 and 1997 were reviewed. In 703 of 829 patients, there was information about clinical features and follow up, and were included in this study. All gallbladders were subjected to a complete mapping. When neoplastic cells involved only the mucosa or muscular layer, the tumors were considered as early. RESULTS: One hundred ninety six patients had an early carcinoma (161 women, aged 57.5 years and 35 male, aged 63.4 years). One hundred twenty eight tumors were located in the mucosa and 68 in the muscular layer. Patients with tumors involving the mucosa were younger than those with tumors involving the muscular layer. All tumors were adenocarcinomas, 66% were well differentiated and 32% moderately differentiated. Tumors were not visible macroscopically in 132 cases. Five and 10 years survival was 92%. Subjects of less than 40 years old had a 100% survival at 5 years. A hepatic and lymph node resection was done in 12 patients with tumors infiltrating the muscular layer but in only one, the tumor infiltrated the liver. No difference in survival was observed when a simple cholecystectomy or radical surgery was done. CONCLUSIONS: Nearly 25% of gallbladder carcinomas can be classified as early and its diagnosis requires a directed study. Simple cholecystectomy is curative for this type of gallbladder cancer.

Analysis of Variance↗

PubMed1975

Lysolecithin-mediated inflammatory reaction in rabbit gallbladder. Permeability increase and enzyme liberation.

Aseptic inflammation in the gallbladder wall was studied in vitro using rabbit gallbladders. Wall permeability changes, measured as changes in the transmural passage of radioactively labelled hippuran and biligraphin as well as enzyme (acid phosphatase) release from wall to lumen were registered as parameters permitting quantitative assessment of an inflammatory process. Lysolecithin, a surface-active substance of possible significance in the pathogenesis of acute cholecystitis was chosen as inflammation-inducing agent. When 6-20 mg/ml lysolecithin was instilled into the gallbladders, dose-dependent increases in permeability and enzyme release occurred. No effects as compared with controls were seen when 2 mg/ml was instilled. Lysolecithin-treated gallbladders showed morphological signs of inflammation as opposed to untreated. The data reported are consistent with earlier observations that lysolecithin may cause inflammatory lesions to the gallbladder wall. The experimental model used may prove useful in examining the effects of aggressive and protective agents upon the gallbladder mucous membrane.

Acid Phosphatase↗

PubMed2001

Anatomical variations of gallbladder and biliary ducts among Ethiopians.

The extrahepatic biliary system was investigated to determine the types and frequency of variations in a group of Ethiopian subjects. A total of 110 specimens were obtained from adult Ethiopian subjects. Each specimen consisting of the whole of the liver, stomach, duodenum and the lesser omentum was removed and dissected carefully to expose the gallbladder and biliary ducts without disturbing their relationship. The majority (51%) of subjects had supramarginal type of gallbladder. The neck and infundibulum of the gallbladder were shorter in the present group compared to reports in other populations. There were significantly more cases of kinking of the gallbladder and Hartmann's pouch in the female than in the male subjects. However, there was no significant difference between the present and previously reported groups as well as the male and female subjects of the present group in the length or course of the cystic, hepatic or bile ducts. The findings in the present study suggest that variations in the gallbladder and the biliary ducts seen in the Ethiopian group are similar to what is reported in other populations. The significantly higher prevalence of kinking of the gallbladder and Hartmann's pouch in the female than in the male subjects may have some contribution to the higher rate of gallstone formation and biliary tract diseases in females.

Adult↗

PubMed2002

Incidental finding of gallbladder carcinoma.

BACKGROUND: Carcinoma of the gallbladder is diagnosed in 0.3-1.5% of all cholecystectomy specimens. OBJECTIVES: To establish the overall rate of gallbladder carcinoma and unexpected gallbladder carcinoma based on our experience. METHODS: We retrospectively evaluated all consecutive cholecystectomies performed in our ward during a 6 year period in order to determine the incidence of gallbladder carcinoma and to identify common characteristics of this particular group of patients. RESULTS: Of the 1,697 cholecystectomies performed in our ward during the 6 years, gallbladder carcinoma was diagnosed in six patients (0.35%) but was not suspected prior to surgery in any of them. In accordance with the literature, the occurrence in women (5/6) was higher than in men (1/6). The mean age was 70 years (range 55-90). The most common symptom was abdominal pain; the majority (5/6) had cholelithiasis, and the pathologic report confirmed the diagnosis of adenocarcinoma in all six patients. CONCLUSIONS: The overall incidence of unsuspected gallbladder carcinoma in our series was 0.35%. We could not find any common characteristics for this particular group of patients when compared to patients with non-malignant pathology.

Age Distribution↗

PubMedDate not supplied

Seeding from early stage gallbladder carcinoma after laparoscopic cholecystectomy.

In the last years laparoscopic cholecystectomy has become the "gold standard therapy" in the treatment of symptomatic cholelitiasis, but it is necessary to keep into account some problems and risks that can arise from laparoscopic technique. One of these risks is represented surely by the disregarding of a gallbladder carcinoma. The authors report a case of peritoneal seeding of an unsuspected gallbladder carcinoma following laparoscopic cholecystectomy. The first histologic diagnosis was chronic ulcerous cholecystitis with adenomiosis but 2 months later the metastasis developed at the umbilical port site, at another port site and to the right lobe of the liver. Another histological sampling of the gallbladder specimen was performed and this time a little intra mucous gallbladder adenocarcinoma was found (T1 stage). While the most part of literature data concern advanced stage of the disease at the time of operation (T2, T3) only few reports regard early stage neoplasm. Therefore this risk is present not only in advanced stages of gallbladder carcinoma but even in cases of early stage cancers. After a laparoscopic cholecystectomy all specimen should be opened and inspected. If there is a gallbladder wall irregularity and if there was a bile spillage it is advisable to perform a preoperative histologic examination.

Adenocarcinoma↗

PubMed2002

Genetic polymorphisms of cytochrome P450 1A1 and risk of gallbladder cancer.

The relation between cytochrome P4501A1 (CYP1A1) gene polymorphisms and the risk of gallbladder cancer was examined. To clarify individual differences in susceptibility to gallbladder carcinogenesis, we investigated the frequency of the Mspl and Ile-Val polymorphisms of the CYP1A1 gene, in 52 patients with gallbladder cancer (32 females, 20 males) and 104 healthy controls (64 females, 40 males). We then examined the relationship between the CYP1A1 polymorphisms and the development of gallbladder cancer in members of both sexes. A statistical difference in the frequencies of the MspI and Ile-Val polymorphisms or their alleles (ml, m2 and Ile, Val) was not observed in the male patients and controls. Among females, however, the frequencies of genotypes C and Ile/Val were significantly higher (p < 0.05) in the patients than in their controls. Moreover, the frequency of the hetero genotype Ile/Val was statistically higher (p < 0.05) in the female patients than in the male patients. This study demonstrated a significant over-representation of genotypes C and Ile/Val in female patients with gallbladder cancer. Females with genotypes C and/or Ile/Val may have a high genetic susceptibility to the development of gallbladder cancer.

Alleles↗

PubMed2002

[A modified technique of gallbladder dissection from the liver during laparoscopic cholecystectomy. Personal technique].

BACKGROUND: Gallbladder injures during cholecystectomy happens more frequently when surgical operation is conduced under laparoscopic (16%) rather than laparotomic (8%) access. A modification of the technique of dissection of the gallbladder from the liver is presented, suggesting a progression from the medium to the lateral side. This technique should facilitate the division of the organs and, above all, limit the gallbladder iatrogenic injures. METHODS: During 1995-2000 we have employed our technique in 637 patients, 89 (14%) affected by acute cholecystytis, subjected to laparoscopic cholecystectomy. RESULTS: Gallbladder injures occurred in 38 cases (6%), with stones liberation 12 (1,9%): 11 had been submitted to surgery in emergency. All patients have been subjected to follow-up from 12 to 30 months. No intraperitoneal abscess was observed, while suppuration of the umbilical port occurred in 12 patients (1,9%): 6 were affected by systemic illnesses. CONCLUSIONS: Our technique can limit the incidence of iatrogenic gallbladder injuries during laparoscopic cholecystectomies, reducing surgical times, antibiotics administration, incidence of perioperative complications. Besides, this technique may facilitate the gallbladder dissection from the liver in case of infundibular stones.

Acute Disease↗

PubMedDate not supplied

Symptomatic or asymptomatic gallstone disease: is the gallbladder motility the clue?

BACKGROUND/AIMS: Only a minority of gallstone patients develop biliary pain. Until now, the factors related to pain have been poorly described. METHODOLOGY: In a prospective study, gallstone patients without acute cholecystitis, pancreatitis or hepatobiliary obstruction were classified into typical symptomatic (type-I, n = 44), atypical symptomatic (type-II, n = 14) and asymptomatic (type-III, n = 29) using a standardized questionnaire (8 items for typical, 3 items for unspecific complaints). Demographic data, body mass index, number and size of gallstones, gallbladder wall thickness and motility after a standardized meal were assessed (ultrasound study) in patients, results were compared to controls without hepatobiliary disease. RESULTS: The gallbladder contractility was similar to controls in type-I (67%) but diminished in II (55%) and III (46%, P < 0.05). Type-I showed lower fasting (P < 0.05) and postprandial gallbladder volumes (P < 0.0005) and was associated with smaller stones (P < 0.0001), younger age (P < 0.0001) and female gender (P < 0.001). Body mass index, stone number and gallbladder wall thickness was not related to pain. CONCLUSIONS: A sluggish gallbladder may protect from biliary pain. The consideration of gallbladder motility and further risk factors (small stones, younger age and female gender) may help to predict the clinical course of gallstone patients, define atypical complaints as biliary related and select patients for treatment.

Adult↗

PubMed2002

Gingival metastasis from gallbladder cancer.

Gallbladder cancer is generally diagnosed at an advanced stage. The liver is the most commonly invaded organ by direct extension and/or metastasis, followed by regional lymph nodes. Oral soft tissue metastasis is extremely unusual. This report describes the case of a 62-year-old woman diagnosed with advanced metastatic gallbladder cancer, who initially presented with abdominal pain. Diagnosis of gallbladder cancer was made about 3 months after her symptoms developed, when a laparoscopic cholecystectomy was performed because of the suspicion of gallstones. Liver metastasis was also discovered during surgery. A postoperative investigation revealed additional lung and bone metastases. A visible left gingival tumor was found on physical examination and was confirmed as gallbladder cancer metastasis by compatible histopathology 1 month after surgery. The patient responded poorly to chemotherapy and unfortunately died 5 months after the diagnosis. The clinical presentation of gallbladder cancer was relatively typical, apart from the unusual gingival metastasis. The medical literature contains quite a few examples of metastatic lesions located strictly in the oral soft tissue, however no case of gallbladder cancer metastasizing to the oral soft tissue has been previously reported.

Female↗