-
International Journal of Surgery Case... Jul 2024The modern-day gold standard treatment of acute cholecystitis is laparoscopic surgery. It is, however, associated with a higher risk of bile duct injury (0.1 %-1.5 %)...
INTRODUCTION
The modern-day gold standard treatment of acute cholecystitis is laparoscopic surgery. It is, however, associated with a higher risk of bile duct injury (0.1 %-1.5 %) when compared to the open approach.
CASE PRESENTATION
We report a case of a patient with an acute cholecystitis in which we performed a laparoscopic cholecystectomy. We faced a destabilizing anatomy with what looked like the gallbladder and an unidentified mass, interpreted as a possible common bile duct cyst. Careful dissection allowed us to determine that what looked like a common bile duct cyst was a dilatation of "Hartmann's pouch" due to a large gallstone.
DISCUSSION
Laparoscopic cholecystectomy reduces length of hospitalization and enhance intra-operative and postoperative morbidity compared with open cholecystectomy. It may increase the risk of bile duct injury, notably in an acute setting due to inflammation and an unclear anatomy. Hartmann's pouch with the infundibulum can sometimes unexpectedly be present beneath the common hepatic duct. In order to avoid bile duct injury, notably in an acute setting, a surgical technique was developed, the Critical View of Safety. It is a method whose sole aim is to secure identification of the cystic structures.
CONCLUSION
Understanding the anatomy allowed for an ultimately safe laparoscopic cholecystectomy. It is strongly advised that, in the event of atypical anatomy, a second opinion is asked of another and/or more experimented surgeon.
PubMed: 38833902
DOI: 10.1016/j.ijscr.2024.109760 -
Radiology Case Reports Aug 2024Portal cavernoma cholangiopathy (PCC) refers to morphological changes in the intrahepatic, extrahepatic biliary system, along with the gallbladder (GB), induced by...
Portal cavernoma cholangiopathy (PCC) refers to morphological changes in the intrahepatic, extrahepatic biliary system, along with the gallbladder (GB), induced by portal cavernoma (PC). Acute acalculous cholecystitis (AAC) represents an infrequent clinical manifestation of PCC. Given the inadequacy of documentation within medical literature, AAC may go undiagnosed among patients with PC presenting symptoms of right upper quadrant pain. The current study aims to report a case of acute acalculous cholecystitis secondary to portal cavernoma, focusing on radiological findings, with a brief review of literature.
PubMed: 38832340
DOI: 10.1016/j.radcr.2024.04.072 -
Future Science OA 2024The aim is to evaluate laparoscopic cholecystectomy safety based on American Society of Anesthesiologists score for acute cholecystitis in patients with comorbidities....
The aim is to evaluate laparoscopic cholecystectomy safety based on American Society of Anesthesiologists score for acute cholecystitis in patients with comorbidities. This is retrospective study of patients who underwent laparoscopic cholecystectomy for acute cholecystitis between 2003 and 2021. According to their respective ASA-score, patients were divided into group 1: ASA1-2 and group 2: ASA3-4. We collected 578 patients. Even though the gangrenous forms were more frequent and the operative time was longer in group 2, laparoscopic cholecystectomy seems safe and effective. We didn't observe any differences in terms of intraoperative incidents, open conversion rate, or postoperative complications compared with other patients. ASA3-4 patients with acute cholecystitis don't face elevated risks of complications or mortality during laparoscopic cholecystectomy.
PubMed: 38827793
DOI: 10.2144/fsoa-2023-0185 -
Asian Journal of Surgery May 2024This study aimed to investigate the impact of preoperative gallbladder drainage and the specific drainage method used on surgical outcomes in patients undergoing surgery...
AIM
This study aimed to investigate the impact of preoperative gallbladder drainage and the specific drainage method used on surgical outcomes in patients undergoing surgery for acute cholecystitis.
METHODS
This single-center retrospective cohort study included 221 patients who underwent early cholecystectomy between January 2016 and December 2020. Clinical data and outcomes of 140 patients who did not undergo drainage, 22 patients who underwent preoperative percutaneous transhepatic gallbladder drainage (PTGBD), and 59 patients who underwent preoperative endoscopic naso-gallbladder drainage (ENGBD) were compared.
RESULTS
There was no difference in the operation time, blood loss, postoperative complications, or length of postoperative hospital stay between patients who did and did not undergo drainage. Among patients who underwent drainage, there was no difference between the ENGBD and PTGBD groups in operation time, blood loss, or postoperative complications; however, more patients in the PTGBD group underwent laparotomy and had a significantly longer postoperative hospital stay. The presence and type of drainage were not risk factors for postoperative complications.
CONCLUSION
The presence or absence of preoperative gallbladder drainage for acute cholecystitis and the type of drainage may not significantly affect surgical outcomes.
PubMed: 38824020
DOI: 10.1016/j.asjsur.2024.05.168 -
World Journal of Gastrointestinal... May 2024Acute cholecystitis (AC) is a common disease in general surgery. Laparoscopic cholecystectomy (LC) is widely recognized as the "gold standard" surgical procedure for...
Evaluating effectiveness and safety of combined percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in acute cholecystitis patients: Meta-analysis.
BACKGROUND
Acute cholecystitis (AC) is a common disease in general surgery. Laparoscopic cholecystectomy (LC) is widely recognized as the "gold standard" surgical procedure for treating AC. For low-risk patients without complications, LC is the recommended treatment plan, but there is still controversy regarding the treatment strategy for moderate AC patients, which relies more on the surgeon's experience and the medical platform of the visiting unit. Percutaneous transhepatic gallbladder puncture drainage (PTGBD) can effectively alleviate gallbladder inflammation, reduce gallbladder wall edema and adhesion around the gallbladder, and create a "time window" for elective surgery.
AIM
To compare the clinical efficacy and safety of LC or PTGBD combined with LC for treating AC patients, providing a theoretical basis for choosing reasonable surgical methods for AC patients.
METHODS
In this study, we conducted a clinical investigation regarding the combined use of PTGBD tubes for the treatment of gastric cancer patients with AC. We performed searches in the following databases: PubMed, Web of Science, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Database. The search encompassed literature published from the inception of these databases to the present. Subsequently, relevant data were extracted, and a meta-analysis was conducted using RevMan 5.3 software.
RESULTS
A comprehensive analysis was conducted, encompassing 24 studies involving a total of 2564 patients. These patients were categorized into two groups: 1371 in the LC group and 1193 in the PTGBD + LC group. The outcomes of the meta-analysis revealed noteworthy disparities between the PTGBD + LC group and the LC group in multiple dimensions: (1) Operative time: Mean difference (MD) = 17.51, 95%CI: 9.53-25.49, < 0.01; (2) Conversion to open surgery rate: Odds ratio (OR) = 2.95, 95%CI: 1.90-4.58, < 0.01; (3) Intraoperative bleeding loss: MD = 32.27, 95%CI: 23.03-41.50, < 0.01; (4) Postoperative hospital stay: MD = 1.44, 95%CI: 0.14-2.73, = 0.03; (5) Overall postoperative complication rate: OR = 1.88, 95%CI: 1.45-2.43, < 0.01; (6) Bile duct injury: OR = 2.17, 95%CI: 1.30-3.64, = 0.003; (7) Intra-abdominal hemorrhage: OR = 2.45, 95%CI: 1.06-5.64, = 0.004; and (8) Wound infection: OR = 0. These findings consistently favored the PTGBD + LC group over the LC group. There were no significant differences in the total duration of hospitalization [MD = -1.85, 95%CI: -4.86-1.16, = 0.23] or bile leakage [OR = 1.33, 95%CI: 0.81-2.18, = 0.26] between the two groups.
CONCLUSION
The combination of PTGBD tubes with LC for AC treatment demonstrated superior clinical efficacy and enhanced safety, suggesting its broader application value in clinical practice.
PubMed: 38817274
DOI: 10.4240/wjgs.v16.i5.1407 -
Annals of Medicine Dec 2024Early diagnosis of acute gallstone pancreatitis severity (GSP) is challenging in clinical practice. We aimed to investigate the efficacy of CT features and radiomics for...
BACKGROUND
Early diagnosis of acute gallstone pancreatitis severity (GSP) is challenging in clinical practice. We aimed to investigate the efficacy of CT features and radiomics for the early prediction of acute GSP severity.
METHODS
We retrospectively recruited GSP patients who underwent CT imaging within 48 h of admission from tertiary referral centre. Radiomics and CT features were extracted from CT scans. The clinical and CT features were selected by the random forest algorithm to develop the ML GSP model for the identification of severity of GSP (mild or severe), and its predictive efficacy was compared with radiomics model. The predictive performance was assessed by the area under operating characteristic curve. Calibration curve and decision curve analysis were performed to demonstrate the classification performance and clinical efficacy. Furthermore, we built a web-based open access GSP severity calculator. The study was registered with ClinicalTrials.gov (NCT05498961).
RESULTS
A total of 301 patients were enrolled. They were randomly assigned into the training ( = 210) and validation ( = 91) cohorts at a ratio of 7:3. The random forest algorithm identified the level of calcium ions, WBC count, urea level, combined cholecystitis, gallbladder wall thickening, gallstones, and hydrothorax as the seven predictive factors for severity of GSP. In the validation cohort, the areas under the curve for the radiomics model and ML GSP model were 0.841 (0.757-0.926) and 0.914 (0.851-0.978), respectively. The calibration plot shows that the ML GSP model has good consistency between the prediction probability and the observation probability. Decision curve analysis showed that the ML GSP model had high clinical utility.
CONCLUSIONS
We built the ML GSP model based on clinical and CT image features and distributed it as a free web-based calculator. Our results indicated that the ML GSP model is useful for predicting the severity of GSP.
Topics: Humans; Pancreatitis; Female; Gallstones; Male; Machine Learning; Tomography, X-Ray Computed; Middle Aged; Retrospective Studies; Severity of Illness Index; Adult; Aged; Acute Disease; Predictive Value of Tests; Early Diagnosis; Algorithms; ROC Curve
PubMed: 38813815
DOI: 10.1080/07853890.2024.2357354 -
Heliyon May 2024To determine the accuracy of Tc-99 m sestamibi for the diagnosis of acute cholecystitis during a supply chain disruption of mebrofenin.
PURPOSE
To determine the accuracy of Tc-99 m sestamibi for the diagnosis of acute cholecystitis during a supply chain disruption of mebrofenin.
MATERIAL AND METHODS
During a national shortage of Tc-99 m mebrofenin in 2019, our institution initiated sestamibi imaging for suspected cases of acute cholecystitis using a standard hepatobiliary imaging protocol. Forty-one patients underwent hepatobiliary imaging with sestamibi, 39 to assess for acute cholecystitis. The examinations were initially interpreted by one nuclear medicine physician and subsequently overread by 5 blinded nuclear medicine physicians (8-30 years' experience). SPECT/CT was obtained for 8 of these patients at the discretion of the primary interpreter. An additional 23 asymptomatic patients (6 with prior cholecystectomy) underwent abdominal scintigraphy as a negative control to determine the normal time to sestamibi accumulation in the gallbladder. A composite reference standard was used (chart review by 3 physicians). Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values were calculated with and without SPECT/CT (mean ± 95%CI).
RESULTS
Of 39 symptomatic patients, 17/39 had acute cholecystitis and 22 did not. The sensitivity, specificity, PPV and NPV for acute cholecystitis at planar imaging were 97.6 ± 4.6, 62.7 ± 5.2, 67.0 ± 3.6, and 97.3 ± 5.2 % (N = 39). The values changed to 95.7 ± 4.7, 77.9 ± 4.7, 72.1 ± 4.1, and 97.0 ± 3.3 % when control patients were included (N = 62). With SPECT/CT, these mildly improved to 98.8 ± 2.3 %, 69.1 ± 4.4 %, 71.3 ± 3.2 %, and 98.7 ± 2.6 % (N = 39), but not significantly different. On average, sestamibi activity was detected in the gallbladder in negative controls within 1 h.
CONCLUSION
Tc-99 m sestamibi has excellent sensitivity and NPV for diagnosing acute cholecystitis and can serve as an alternative when mebrofenin is unavailable for evaluating cystic duct obstruction during shortages of standard agents.
PubMed: 38813191
DOI: 10.1016/j.heliyon.2024.e31257 -
Cureus May 2024Acute cholecystitis is an inflammatory condition of the gallbladder, characterized by infection, ulceration, and neutrophilic infiltration of the gallbladder wall....
Acute cholecystitis is an inflammatory condition of the gallbladder, characterized by infection, ulceration, and neutrophilic infiltration of the gallbladder wall. Approximately 90% of cases are caused by gallstones. In contrast, acalculous cholecystitis is defined as the inflammation of the gallbladder in the absence of gallstones during diagnosis. The causes of acalculous cholecystitis include impaired blood flow to the gallbladder, chemical injury, bacterial or parasitic infections, and collagen vascular diseases. However, in this case, it was caused by an extremely rare condition: a duodenal ulcer penetration. Physical examination, blood tests, and ultrasound suggested a diagnosis of acute cholecystitis. However, contrast-enhanced CT showed no gallstones and revealed a partial mucosal defect in the first portion of the anterior duodenum. There was also wall thickening and increased density of the surrounding fat tissue, particularly around the gallbladder wall adjacent to the first portion of the anterior duodenum. Based on these findings, secondary cholecystitis due to perforation of a duodenal ulcer was diagnosed, and laparoscopic cholecystectomy with omental patching was performed. Although rare, a duodenal ulcer should be considered as a cause of acalculous cholecystitis.
PubMed: 38813075
DOI: 10.7759/cureus.61293 -
Medical Ultrasonography May 2024Gallbaldder disorders represent a prevalent pathology encounterd in daily practice, both in emergency and ambulatory settings. Transabdominal ultrasound has a high... (Review)
Review
Gallbaldder disorders represent a prevalent pathology encounterd in daily practice, both in emergency and ambulatory settings. Transabdominal ultrasound has a high accuracy for the diagnosis of gallstones and acute cholecystitis. Contrast enhanced ultrasound (CEUS) can depict and characterized the vascular pattern in cases of inflammatory or malignant processes. In an emergency situation such as acute cholecystitis in patients with comorbidities, CEUS can acurate identify a gangrenous cholecystitis; subsequently the medical management can rely on this technique. The differential diagnosis of benign vs malignant pathology, in cases of segmental or diffuse wall thickening, can also benefit from CEUS. In this paper we aimed to discuss and to illustrate the role of CEUS in gallbladder pathology.
PubMed: 38805618
DOI: 10.11152/mu-4382 -
Updates in Surgery May 2024Fluorescence imaging is a real-time intraoperative navigation modality to enhance surgical vision and it can guide emergency surgeons while performing difficult,...
Knowledge, attitudes and practices of using Indocyanine Green (ICG) fluorescence in emergency surgery: an international web-based survey in the ARtificial Intelligence in Emergency and trauma Surgery (ARIES)-WSES project.
Fluorescence imaging is a real-time intraoperative navigation modality to enhance surgical vision and it can guide emergency surgeons while performing difficult, high-risk surgical procedures. The aim of this study is to assess current knowledge, attitudes, and practices of emergency surgeons in the use of indocyanine green (ICG) in emergency settings. Between March 08, 2023 and April 10, 2023, a questionnaire composed of 27 multiple choice and open-ended questions was sent to 200 emergency surgeons who had previously joined the ARtificial Intelligence in Emergency and trauma Surgery (ARIES) project promoted by the WSES. The questionnaire was developed by an emergency surgeon with an interest in advanced technologies and artificial intelligence. The response rate was 96% (192/200). Responders affirmed that ICG fluorescence can support the performance of difficult surgical procedures in the emergency setting, particularly in the presence of severe inflammation and in evaluating bowel viability. Nevertheless, there were concerns regarding accessibility and availability of fluorescence imaging in emergency settings. Eighty-seven out of 192 (45.3%) respondents have a fluorescence imaging system of vision for both elective and emergency surgical procedures; 32.3% of respondents have this system solely for elective procedures; 21.4% of respondents do not have this system, 15% do not have experience with it, and 38% do not use this imaging in emergency surgery. Less than 1% (2/192) affirmed that ICG fluorescence changed always their intraoperative decision-making. Precision surgery effectively tailors surgical interventions to individual patient characteristics using advanced technology, data analysis and artificial intelligence. ICG fluorescence can serve as a valid and safe tool to guide emergency surgery in different scenarios, such as intestinal ischemia and severe acute cholecystitis. Due to the lack of high-level evidence within this field, a consensus of expert emergency surgeons is needed to encourage stakeholders to increase the availability of fluorescence imaging systems and to support emergency surgeons in implementing ICG fluorescence in their daily practice.
PubMed: 38801604
DOI: 10.1007/s13304-024-01853-z