[Metaplasia of the gallbladder mucosa in chronic cholecystitis--with special reference to duodenalization of the cholecystic mucosa (author's transl)].
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Adolescent↗
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Results for “Cholecystitis”
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[When is cholecystostomy necessary in acute cholecystitis? (for discussion apropos of A.M. Tetdoev and Iu. M. Stoĭko's article. "Is Cholecystostomy Necessary in Acute Cholecystitis Complicated by Jaundice")].
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Acute Disease↗
Intravenous cholangiography in the diagnosis of acute cholecystitis.
We reviewed our experience with intravenous cholangiography in the evaluation of 70 patients with suspected acute cholecystitis. Twenty-one of these patients had visualization of the biliary ducts without opacification of the gallbladder, a roentgenographic finding that was considered diagnostic of acute cholecystitis. Twenty of the 21 patients were noted to have acute cholecystitis during exploratory laparotomy. The remaining patient had a normal gallbladder, but was found to have a liver abscess. Opacification of the gallbladder with evidence of gallstones was found in eight patients; all had acute cholecystitis. Visualization of the gallbladder without gallstones was found in 22 patients, revealing no acute cholecystitis in this group. Many of these patients were admitted to the hospital with a primary diagnosis of acute cholecystitis and were spared an unnecessary surgical exploration. Nineteen patients had nonvisualization of the gallbladder and biliary ducts. This roentgenographic finding may be caused by acute intra-abdominal conditions other than cholecystitis and caution is warranted in its interpretation. This test has been found to be a reliable adjunct in the work-up of patients with suspected acute cholecystitis.
Acute Disease↗
Wound infection. Acute versus chronic cholecystitis.
Wound infection in 239 patients who underwent cholecystectomy were analyzed retrospectively. Seventeen per cent of the patients with acute cholecystitis had wound infection compared with 8.9 per cent of patients with chronic cholecystitis. Bacteriology of wound infections revealed Staphylococcus aureus in 76.4 per cent of the chronic cholecystitis group and in 12.5 per cent of the acute cholecystitis group. Wound infection in the acute cholecystitis group involved gram-negative rods predominantly. Organisms were isolated from bile culture in 71.4 per cent of acute cholecystitis patients compared with 59.6 per cent of chronic cholecystitis patients. Of patients with positive bile cultures 11.3 per cent had wound infections compared with 6.8 per cent of patients with negative bile cultures. The most common organisms isolated from bile cultures with resultant wound infections were S epidermis, S aureus, and Klebsiella sp. Wound infection after cholecystectomy for chronic cholecystitis arises from external sources and not contaminated bile. Antibiotic therapy should be directed accordingly.
Acute Disease↗
[Intravenous cholegraphy and diaphragmatic movements in the differential diagnosis of acute cholecystitis (author's transl)].
Intravenous cholegraphy was performed in 79 patients with abdominal symptoms suggestive of acute cholecystitis. Three excretion patterns were found: 1. Opacification of the gall bladder and common bile duct. 2. Opacification of the common bile duct. 3. No opacification of the gall bladder or common bile duct. 29% showed opacification of the gall bladder and common bile duct; none of these had acute cholecystitis. 51% of cases showed opacification of the common bile duct only; 82.5% of these had acute cholecystitis. 79.4% of patients with this excretion pattern were shown to have acute cholecystitis at operation. In the other cases, absence of opacification of the gall bladder was due to obstruction of the cystic duct, caused either by concretions or fibrosis. The biliary tree was not visible in 21% of cases. The most common diagnosis was acute cholecystitis, but this excretion pattern is of limited value in differential diagnosis. The value of this examination is stressed, but it must be carried on for an adequate period. Mobility of the right diaphragm was examined preoperatively in 34 patients. Compared with patients with other diagnoses, there was a significant number of patients with acute cholecystitis who showed limited movement. The examination may be regarded as supplementary to intravenous cholegraphy in the diagnosis of acute cholecystitis.
Abdomen, Acute↗
[Diagnosis and treatment of cholecystitis].
In the period from 1963 til 1978 the authors observed 1084 patients with cholecystitis. Operations were performed on 336 patients. Acute cholecystitis was diagnosed in 190 patients, chronic calculous cholecystitis--in 128 patients, chronic acalculous cholecystitis--in 18 cases. In acute cholecystitis the active-temporizing tactics was used. Urgent operations were performed on patients with peritonitis. In other variants the conservative treatment was prescribed. When the patient's condition was stated to improve, the surgical treatment was performed if indicated. Patients with chronic calculous cholecystitis were operated on diagnosing. Chronic acalculous cholecystitis was an indication for surgery in cases of frequent attacks of hepatic colic and inefficiency of the conservative therapy.
Acute Disease↗
A comparative appraisal of emphysematous cholecystitis.
There is ample evidence from this retrospective comparison to indicate that emphysematous cholecystitis does merit clinical distinction apart from acute cholecystitis. It is an acute infection of the gallbladder caused by a specific group of bacteria that may be aided by some aspect of local ischemia. Cholelithiasis does not seem to be a major factor in the pathogenesis of emphysematous cholecystitis, and this, in association with some dependence upon ischemia, may account for the predominance of this disease in males rather than females. Gangrene is a common feature of the pathologic process, and thus it is not surprising that the diagnosis of emphysematous cholecystitis implies a risk of gallbladder perforation that is five times that expected from ordinary acute cholecystitis. The key to identifying this disease is the plain abdominal roentgenogram which in most instances will make the diagnosis and provide an impetus for early operative intervention.
Cholecystitis↗
Infusion cholecystography--an aid in the diagnosis of acute cholecystitis.
Early operation of patients with acute cholecystitis is nowadays accepted as the treatment of choice. One prerequisite for this policy is, however, the availability of diagnostic procedures that can rapidly secure or, even more important, exclude the diagnosis to avoid unnecessary operations. Infusion cholecystography was here shown to be an accurate method giving decisive information in patients with clinically suspected acute cholecystitis. The gallbladder was not visualized in 26 out of 45 patients with inconclusive clinical signs of acute cholecystitis. The diagnosis of acute cholecystitis was confirmed at operation or by a typical clinical course in these 26 patients. In the 19 patients with visualized gallbladder diagnosis other than acute cholecystitis were established by acute operation or by other means.
Acute Disease↗
Gallium gallbladder scanning in cholecystitis.
Gallium has been shown to accumulate in metabolically active tissue including sites of infection. The purpose of this study was to evaluate gallium scanning in cholecystitis. Ten patients with cholecystitis were studied using conventional gallium scanning techniques. Five patients with acute cholecystitis showed intense gallium accumulation in the gallbladder area. One of five patients with chronic cholecystitis showed significant accumulation in the gallbladder. The limitations of this method are mainly the need for serial scanning to rule out gallium accumulation in the hepatic flexure of the colon and also the failure to detect consistently a chronically diseased fibrotic gallbladder. We conclude that gallium scanning of the gallbladder is an important adjunctive study in the evaluation of cholecystitis.
Adult↗
Postoperative acute acalculous cholecystitis.
Two patients with acute acalculous cholecystitis after major surgical operations (cystectomy ad modum Bricker because of carcinoma of the urinary bladder, and proctocolectomy because of ulcerative colitis) are described. Various possible causes of acalculous cholecystitis after operation or after trauma are discussed. Postoperative acute acalculous cholecystitis has a more fulminant course than ordinary calculous cholecystitis. Treatment consists of immediate cholecystectomy.
Acute Disease↗
[Intravenous cholegraphy in acute cholecystitis (author's transl)].
In this prospective study iv-cholegraphy was performed before surgery on 152 patients by whom acute cholecystitis could not be excluded. The examination was diagnostic in 85% of the cases. Most of the patients (20/23) with nonvisualization of the biliary tract by iv-cholegraphy suffered from acute cholecystitis, the others (3/23) from acute pancreatitis. In three false negative examinations the opacification of the gallbladder was weak and in three false positive cases the cystic duct obstruction was caused by a chronic gallbladder disease. Because the preliminary clinical suspicion of acute cholecystitis even when using rigid criteria proved to be false in 30% of the cases, we consider a radiologic clarification to be indicated. Iv-cholegraphy is found to be an important examination in acute cholecystitis, practicable even at small radiologic departments with conventional equipment, and a reliable indicator of cystic duct obstruction.
Acute Disease↗
Rapid and accurate diagnosis of acute cholecystitis with 99mTc-HIDA cholescintigraphy.
Technetium-99m dimethyl acetanilide iminodiacetic acid (HIDA) cholescintigraphy was performed on 90 patients with suspected acute cholecystitis. Visualization of the gallbladder established patency of the cystic duct and excluded the diagnosis of acute cholecystitis in 50 of 52 patients. Nonvisualization of the gallbladder with visualization of the common bile duct was diagnostic of acute cholecystitis in 38 patients, all subsequently proven at surgery. The observed accuracy of this procedure is 98% and specificity is 100%. The false negative rate is 5% and false positive rate is zero. Technetium-99m-HIDA has many advantages which make it the procedure of choice in evaluating a patient for suspected acute cholecystitis. It is a rapid, simple, safe examination which provides functional as well as anatomic information about the hepatobiliary system in individuals with a serum bilirubin level up to 8 mg/100 ml.
Acetates↗
[The acute calculus cholecystitis in the elderly patients. (Prognosis and therapy (author's transl)].
The Author describes 151 cases of acute cholecystitis in patients ranging from 70 to 95 years of age. He examines then the literature on the subject paying attention to the treatment of cases of acute cholecyst disease in aged patients. The Author shows the outstanding features of these cases in synoptic tables and discusses them making a comparison with the materials and results of the colleagues. Leaving necessarily aside the urgent operations a discussion is made on the choice between a cholecyst extirpation and a cholecyst anastomosis. On course, advantages and disadvantages of such operations in aged and weakened patients are taken into account. Death percentage results to be equal to 26,4%, a figure which is not far from that furnished by other statistics, bearing in mind the age of the patients.
Acute Disease↗
Acute cholecystitis in the elderly: a surgical emergency.
A retrospective review of 88 male patients older than 60 years of age with billiary tract disease showed a mortality of 6.8%. More than 40% of the patients (39 of 88) had acute cholecystitis. Medical therapy failed for almost all of the patients (38 of 39) with acute inflammatory disease and they then required an operation during their initial hospitalization. In this acute disease group, 21% had empyema of the gallbladder, 18% had gangrenous cholecystitis or free perforation of the gallbladder, and 15% had subphrenic or liver abscesses. Escherichia coli and Klebsiella were obtained from 78% of the bile cultures, and obligate anaerobes were present in 25% of them. A delay in diagnosis and operation occurred in 33% of the patients with acute disease. Factors responsible for this delay included a deceptively benign clinical presentation and the requirement for prolonged resuscitation. Since response to conservative measures is unlikely in the elderly patient with acute cholecystitis, optimal management consists of resuscitation and prompt operation for control of infection.
Acute Disease↗
Choledocholithiasis associated with acute cholecystitis.
A retrospective review of the records of 1,507 patients with a diagnosis of cholecystitis was conducted for the five-year period, 1972 to 1977. Of this group of patients, a histopathologic diagnosis of acute cholecystitis was established in 154 patients (10.2%). Common duct calculi were detected in 17 of these 154 patients, an incidence of 11%. Preoperative evaluation by means of serum bilirubin and alkaline phosphatase levels and intravenous cholangiography was unsatisfactory for consistent demonstration of choledocholithiasis in the presence of acute cholecystitis. Intraoperative cholangiography was found to be the most reliable method for detection of common duct calculi and was successfully employed in 14 of 17 patients with choledocholithiasis. The remaining three patients had palpable stones.
Acute Disease↗
Infusion cholecystography in the diagnosis of acute cholecystitis.
The use of infusion cholecystography as an aid in the diagnosis of acute cholecystitis was investigated in 21 patients. Seventeen of 18 patients (94 per cent) with positive cholecyst-tomograms who underwent laparotomy had confirmation of acutely inflamed gallbladders both macroscopically and histologically. These findings suggest that infusion cholecystography can make a significant contribution in reducing the incidence of misdiagnosis in acute cholecystitis, and that the investigation should be part of the management of patients in whom early surgery is planned.
Acute Disease↗
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↗
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↗