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Annals of Medicine and Surgery (2012) May 2024Pucker sign is the depression of the liver in the region of the gallbladder due to a high degree of chronic contractive inflammation of the gallbladder. It usually...
INTRODUCTION
Pucker sign is the depression of the liver in the region of the gallbladder due to a high degree of chronic contractive inflammation of the gallbladder. It usually develops in patients who have a delayed cholecystectomy after acute cholecystitis due to a high degree of chronic contractive inflammation of the gallbladder and contraction of the cystic plate. It is an essential finding either preoperatively or intraoperatively as it can act as a stopping rule during cholecystectomy (act as a guide that cholecystectomy will be difficult).
CASE SERIES
The authors here report three cases of pucker sign that were incidentally discovered during laparoscopy.
DISCUSSION
Chronic cholecystitis is a prolonged, subacute condition caused by inflammation of the gallbladder, which mostly occurs in the setting of cholelithiasis. Laparoscopic cholecystectomy is the procedure of choice for symptomatic cholelithiasis. Hence, it would be beneficial to be aware of reliable signs that predict difficult Laparoscopic cholecystectomy. Pucker sign usually predicts increased operative difficulty as there is an operative danger of biliary or vascular injury.
CONCLUSION
The pucker sign is a novel indicator of significant persistent inflammation and heightened difficulty during surgery. It might establish a halting rule that modifies the procedure's management and raises its level of safety.
PubMed: 38694274
DOI: 10.1097/MS9.0000000000002017 -
Kansas Journal of Medicine 2024
PubMed: 38694174
DOI: 10.17161/kjm.vol17.21594 -
Avicenna Journal of Medicine Jan 2024Conflicting evidence regarding the laparoscopic versus open cholecystectomy outcomes in scientific literature impacts the medical decision-making for patients with... (Review)
Review
Conflicting evidence regarding the laparoscopic versus open cholecystectomy outcomes in scientific literature impacts the medical decision-making for patients with gallbladder disease. This study aimed to compare a range of primary and secondary outcomes between patients receiving laparoscopic cholecystectomy and those with open intervention. Articles published from 1993 to 2023 were explored by utilizing advanced filters of PubMed Central/Medline, Web of Science, CINAHL, JSTOR, Cochrane Library, Scopus, and EBSCO. The gallbladder disease was determined by the presence of one or more of the following conditions: 1) Gangrenous cholecystitis, 2) acute cholecystitis, 3) chronic gallbladder diseases, and 4) cholelithiasis. The primary end-point was mortality, while the secondary outcome included (1) bile leakage, 2) common bile duct injury, 3) gangrene, 4) hospital stay (days), 5) major complications, 6) median hospital stay (days), (7) pneumonia, 8) sick leaves (days), and 9) wound infection. Statistically significant reductions were observed in mortality (odds ratio [OR]: 0.30, 95% confidence interval [CI]: 0.30, 0.45, < 0.00001), mean hospital stay duration (mean difference: -2.68, 95% CI: -3.66, -1.70, < 0.00001), major complications (OR: 0.35, 95% CI: 0.19, 0.64, = 0.0005), post/intraoperative wound infection (OR: 0.29, 95% CI: 0.16, 0.51, < 0.0001), and sick leaves (OR: 0.34, 95% CI: 0.14, 0.80, = 0.01) in patients who underwent laparoscopic cholecystectomy compared with those with the open intervention. No statistically significant differences were recorded between the study groups for bile leakage, common bile duct injury, gangrene, median hospital stay days, and pneumonia ( > 0.05). The pooled outcomes favored the use of laparoscopic cholecystectomy over the open procedure in patients with gallbladder disease. The consolidated findings indicate the higher impact of laparoscopic cholecystectomy in improving patient outcomes, including safety episodes, compared with open cholecystectomy.
PubMed: 38694141
DOI: 10.1055/s-0043-1777710 -
World Journal of Gastrointestinal... Apr 2024Benign gallbladder diseases have become a high-prevalence condition not only in China but also worldwide. The main types of benign gallbladder diseases include...
BACKGROUND
Benign gallbladder diseases have become a high-prevalence condition not only in China but also worldwide. The main types of benign gallbladder diseases include gallbladder polyps, acute and chronic cholecystitis, and gallstones, with gallstones being the most common, accounting for over 70% of cases. Although the mortality rate of benign gallbladder diseases is low, they carry obvious potential risks. Studies have shown that an increased incidence of benign gallbladder diseases can increase the risk of cardiovascular diseases and gallbladder cancer, resulting in a substantial disease burden on patients and their families.
AIM
To assess the medical utility of the Configuration-Procedure-Consequence (CPC) three-dimensional quality evaluation model in modulating the prognosis of laparoscopic cholecystectomy patients.
METHODS
A total of 98 patients who underwent laparoscopic cholecystectomy in our hospital from February 2020 to January 2022 were selected as the subjects. According to the random number table method, they were divided into a study group and a control group, with 49 patients in each group. The control group received routine perioperative care, while the study group had the addition of the CPC three-dimensional quality evaluation. The postoperative recovery-related indicators (time to first flatus, time to oral intake, time to ambulation, hospital stay), stress indicators (cortisol and adrenaline levels), distinctions in anxiety and depression status, and the incidence of perioperative complications were compared.
RESULTS
The time to first flatus, time to oral intake, time to ambulation, and hospital stay of the study group patients were obviously lower than those of the control group patients, with statistical significance ( < 0.05). On the 1 day after admission, there were no obvious distinctions in cortisol and adrenaline levels in blood samples, as well as in the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores between the study group and the control group ( > 0.05). However, on the 3 day after surgery, the cortisol and adrenaline levels, as well as SAS and SDS scores of the study group patients, were obviously lower than those of the control group patients ( < 0.05). The study group had 2 cases of incisional infection and 1 case of pulmonary infection, with a total incidence of complications of 6.12% (3/49), which was obviously lower than the 20.41% (10/49) in the control group ( < 0.05).
CONCLUSION
Implementing the CPC three-dimensional quality evaluation model for patients undergoing laparoscopic cholecystectomy can help accelerate their perioperative recovery process, alleviate perioperative stress symptoms, mitigate anxiety, depression, and other adverse emotions, and to some extent, reduce the incidence of perioperative complications.
PubMed: 38690039
DOI: 10.4240/wjgs.v16.i4.1078 -
International Journal of Surgery Case... Jun 2024Gallbladder volvulus is the rarest form of gall bladder pathology and it is also rare cause of acute abdomen. The exact etiology of gallbladder volvulus is undetermined...
INTRODUCTION
Gallbladder volvulus is the rarest form of gall bladder pathology and it is also rare cause of acute abdomen. The exact etiology of gallbladder volvulus is undetermined and mostly mimics acute cholecystitis which delays diagnosis and management of patients.
CASE PRESENTATION
In this case report we present 7 years old male child who underwent exploratory laparotomy and intraoperative findings of 360 degree twisted, frankly gangrenous, and perforated at the fundus of the gallbladder. Cholecystectomy was done and the patient had smooth post-operative course and discharged improved.
CLINICAL DISCUSSION
Gallbladder volvulus is a rare cause of acute abdomen especially in pediatric population and it mostly mimics acute acalculous cholecystitis leading to delayed diagnosis and increased risk of complications such as gallbladder gangrene, perforation, bile peritonitis, morbidity and mortality.
CONCLUSION
Even though gallbladder volvulus is rare as cause of acute abdomen, one has to consider in the differential diagnosis as high index of suspicion is important for early diagnosis and management.
PubMed: 38688150
DOI: 10.1016/j.ijscr.2024.109664 -
Japanese Journal of Infectious Diseases Apr 2024We report the isolation of Helicobacter cholecystus from a positive blood culture from a 58-year-old man in China who had bacteremia and acute cholecystitis. The...
We report the isolation of Helicobacter cholecystus from a positive blood culture from a 58-year-old man in China who had bacteremia and acute cholecystitis. The patient's condition improved after symptomatic support treatment and subtotal cholecystectomy. This finding suggests that H. cholecystus should be considered as potential human pathogens.
PubMed: 38684428
DOI: 10.7883/yoken.JJID.2023.468 -
POCUS Journal 2024Point of care ultrasound (POCUS) is specific for acute cholecystitis (AC), but surgeons request radiology imaging (RI) prior to admitting patients with POCUS-diagnosed...
BACKGROUND
Point of care ultrasound (POCUS) is specific for acute cholecystitis (AC), but surgeons request radiology imaging (RI) prior to admitting patients with POCUS-diagnosed AC.
OBJECTIVES
We sought to determine the test characteristics of POCUS for AC when performed and billed by credentialed emergency physicians (EPs), the accuracy rate of RI when performed after POCUS, and the time added when RI is requested after POCUS demonstrates AC.
METHODS
We performed a dual-site retrospective cohort study of admitted adult ED patients who had received biliary POCUS from November 1, 2020 to April 30, 2022. Patients with previously diagnosed AC, liver failure, ascites, hepatobiliary cancer, or cholecystectomy were excluded. Descriptive statistics and 95% confidence intervals for point estimates were calculated. Medians were compared using a Wilcoxon signed-rank test. Test characteristics of POCUS for AC were calculated using inpatient intervention for AC as the reference standard.
RESULTS
Of 473 screened patients, 143 were included for analysis: 80 (56%) had AC according to our reference standard. POCUS was positive for AC in 46 patients: 44 true positives and two false positives, yielding a positive likelihood ratio of 17.3 (95%CI 4.4-69.0) for AC. The accuracy rate of RI after positive POCUS for AC was 39.0%. Median time from ED arrival to POCUS and ED arrival to RI were 115 (IQR 64, 207) and 313.5 (IQR 224, 541) minutes, respectively; p < 0.01.
CONCLUSION
RI after positive POCUS performed by credentialed EPs takes additional time and may increase diagnostic uncertainty.
PubMed: 38681169
DOI: 10.24908/pocus.v9i1.16596 -
International Journal of Surgery Case... Jun 2024acute acalculous cholecystitis (AAC) is defined as gallbladder inflammation without the presence of stones. Contrary, hepatitis A virus (HAV) can present with different...
INTRODUCTION
acute acalculous cholecystitis (AAC) is defined as gallbladder inflammation without the presence of stones. Contrary, hepatitis A virus (HAV) can present with different symptoms; however, HAV causing and presenting as AAC is rare.
CASE PRESENTATION
41-year-old previously healthy patient presented with right upper quadrant abdominal pain. The pain was persistent and associated with vomiting and laboratory tests showed elevated bilirubin. Laparoscopic cholecystectomy showed inflamed gallbladder with no stones and intraoperative cholangiography showed no abnormalities. Day one post-operation, while the pain resolved, labs showed elevated liver function tests and hepatitis workup showed acute HAV infection attributing her presentation to HAV induced AAC.
DISCUSSION
AAC is usually caused by stasis of the gallbladder due to different causes; however, HAV induced AAC has been rarely reported. While cholecystectomy is the mainstay treatment for AAC, this might not be the case for HAV induced AAC. For instance, unless there is necrotic gallbladder or persistence of symptoms, AAC can be managed conservatively in this case. Even though our diagnosis was cleared post-operatively, had we knew the diagnosis of HAV induced AAC before, we would have still opt for surgery due to the severity and persistence of pain.
CONCLUSION
More cases should be reported and more studies should be done to further define the presentation and management of HAV induced AAC.
PubMed: 38677257
DOI: 10.1016/j.ijscr.2024.109687 -
Medicina (Kaunas, Lithuania) Apr 2024In recent years, therapeutic endoscopy has become a fundamental tool in the management of gallbladder diseases in light of its minimal invasiveness, high clinical... (Review)
Review
In recent years, therapeutic endoscopy has become a fundamental tool in the management of gallbladder diseases in light of its minimal invasiveness, high clinical efficacy, and good safety profile. Both endoscopic transpapillary gallbladder drainage (TGBD) and endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD) provide effective internal drainage in patients with acute cholecystitis unfit for cholecystectomy, avoiding the drawbacks of external percutaneous gallbladder drainage (PGBD). The availability of dedicated lumen-apposing metal stents (LAMS) for EUS-guided transluminal interventions contributed to the expansion of endoscopic therapies for acute cholecystitis, making endoscopic gallbladder drainage easier, faster, and hence more widely available. Moreover, EUS-GBD with LAMS opened the possibility of several cholecystoscopy-guided interventions, such as gallstone lithotripsy and clearance. Finally, EUS-GBD has also been proposed as a rescue drainage modality in malignant biliary obstruction after failure of standard techniques, with encouraging results. In this review, we will describe the TBGD and EUS-GBD techniques, and we will discuss the available data on clinical efficacy in different settings in comparison with PGBD. Finally, we will comment on the future perspectives of EUS-GBD, discussing the areas of uncertainty in which new data are more strongly awaited.
Topics: Humans; Drainage; Endosonography; Cholecystitis, Acute; Gallbladder; Stents; Endoscopy; Gallbladder Diseases
PubMed: 38674279
DOI: 10.3390/medicina60040633 -
The American Surgeon Apr 2024Preoperative Coronavirus Disease 2019 (COVID-19) infections are associated with postoperative adverse outcomes. However, there is limited data on the impact of...
Preoperative Coronavirus Disease 2019 (COVID-19) infections are associated with postoperative adverse outcomes. However, there is limited data on the impact of postoperative COVID-19 infection on postoperative outcomes of common general surgery procedures. To evaluate the impact of postoperative COVID-19 diagnosis on laparoscopic cholecystectomy outcomes. Patients with symptomatic cholelithiasis, acute cholecystitis, or gallstone pancreatitis who underwent laparoscopic cholecystectomy with or without intraoperative cholangiogram were identified using the 2021 National Surgical Quality Improvement Program (NSQIP) database. Patients were categorized into two groups: patients with and without a postoperative COVID-19 diagnosis. Coarsened Exact Matching was used to match the groups based on preoperative risk factors, and outcomes were compared. A total of 47,948 patients were included. In the aggregate cohort, 31% were male, and mean age was 50 years. Age, BMI, smoking, COPD, CHF, preoperative sepsis, and ASA class were significantly different between the two groups. After matching, there were no differences in characteristics. 30-day morbidity (OR = 2.7, 95% CI 1.4-5.1), pneumonia (OR = 5.0, 95% CI 1.7-15.0), DVT (OR = 8.22, 95% CI 1.0-66), reoperation (OR = 9.3, 95% CI 1.2-73.8), and readmission (OR = 4.8, 95% CI 2.3-10.1) continued to be significantly worse in the matched cohort. Postoperative COVID-19 infection was associated with worse outcomes after laparoscopic cholecystectomy. These findings suggest that even postoperative COVID-19 diagnosis increases the risk for adverse outcomes in patients recovering from laparoscopic cholecystectomy and may indicate that precautions should be taken and new COVID-19 infections even after surgery should be closely monitored.
PubMed: 38655851
DOI: 10.1177/00031348241248800