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Viruses Mar 2024Acute acalculous cholecystitis (AAC) represents cholecystitis without gallstones, occurring in approximately 5-10% of all cases of acute cholecystitis in adults. Several... (Review)
Review
Acute acalculous cholecystitis (AAC) represents cholecystitis without gallstones, occurring in approximately 5-10% of all cases of acute cholecystitis in adults. Several risk factors have been recognized, while infectious diseases can be a cause of cholecystitis in otherwise healthy people. Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has spread worldwide, leading to an unprecedented pandemic. The virus enters cells through the binding of the spike protein to angiotensin-converting enzyme 2 (ACE2) receptors expressed in many human tissues, including the epithelial cells of the gastrointestinal (GI) tract, and this explains the symptoms emanating from the digestive system. Acute cholecystitis has been reported in patients with COVID-19. The purpose of this review is to provide a detailed analysis of the current literature on the pathogenesis, diagnosis, management, and outcomes of AAC in patients with COVID-19.
Topics: Adult; Humans; COVID-19; SARS-CoV-2; Acalculous Cholecystitis; Peptidyl-Dipeptidase A; Cholecystitis, Acute; Cholecystitis
PubMed: 38543820
DOI: 10.3390/v16030455 -
Middle East Journal of Digestive... Oct 2023Cystic artery pseudoaneurysm due to acute on chronic cholecystitis is very rare in spite of the high incidence of cholecystitis, and very few cases have been reported in...
Cystic artery pseudoaneurysm due to acute on chronic cholecystitis is very rare in spite of the high incidence of cholecystitis, and very few cases have been reported in the literature. Most of the pseudoaneurysms are symptomatic at the time of diagnosis due to rupture. Very few cases of unruptured cystic artery pseudoaneurysm caused by cholecystitis have been reported in the literature. We present a case of a 41-year-old man who presented in the Intervention Radiology Department with the diagnosis of cholecystitis and cystic artery pseudoaneurysm. Three treatment options are available for such cases. The first approach is surgical clipping of the pseudoaneurysm and cholecystectomy. The second approach is endovascular management of pseudoaneurysm and cholecystectomy. We chose the third approach, endovascular management of the pseudoaneurysm, percutaneous cholecystostomy, and elective laparoscopic cholecystectomy.
PubMed: 38523887
DOI: 10.34172/mejdd.2023.359 -
Frontiers in Pediatrics 2024This study aimed to investigate specific clinical diagnostic methods for children with infectious mononucleosis (IM) complicated by acute acalculous cholecystitis (AAC).
OBJECTIVE
This study aimed to investigate specific clinical diagnostic methods for children with infectious mononucleosis (IM) complicated by acute acalculous cholecystitis (AAC).
METHODS
We conducted a retrospective analysis of 171 cases of IM diagnosed in the infectious disease ward of Children's Hospital of Nanjing Medical University between January 2020 and December 2020. All IM patients underwent abdominal ultrasound examinations to assess the liver, gallbladder, and spleen. Fourteen patients with symptoms of AAC underwent a follow-up assessment one week later.
RESULTS
The estimated incidence of AAC in hospitalized IM children was 8.2%. Both groups of patients presented with fever, abdominal pain, and eyelid edema upon admission. Characteristic radiological findings of AAC were observed, including gallbladder (GB) distention, increased GB wall thickness and increased common bile duct diameter. Analysis of laboratory results revealed no statistically significant differences in leukocyte, absolute lymphocyte count, CD3+, CD3 + CD4+, CD3+ CD8+, Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), or Gamma-Glutamyl Transferase (GGT) levels between the AAC(+) and AAC(-) groups on admission. However, these parameters were not significant risk factors for AAC. After discharge, relevant indicators in non-AAC patients gradually decreased to normal levels, while those in AAC(+) patients did not show a significant decrease.
CONCLUSION
While cases of IM complicated by AAC are relatively uncommon, the utilization of abdominal ultrasound offers a reliable tool for confirming this diagnosis. Routine abdominal ultrasound examinations are recommended for IM patients to improve early detection and treatment of associated conditions.
PubMed: 38523838
DOI: 10.3389/fped.2024.1339920 -
Cureus Feb 2024, a gram-negative, rod-shaped, anaerobic bacterium, is a rare cause of human disease. species have been known to mostly cause pulmonary disease in agricultural...
, a gram-negative, rod-shaped, anaerobic bacterium, is a rare cause of human disease. species have been known to mostly cause pulmonary disease in agricultural workers as they are native to select crops and wild animal furs. However, in very few documented cases, has been discovered as the source of nosocomial infections, usually in the setting of an immunocompromised host. This case report details the clinical course of a 62-year-old immunocompromised female with stage 3 breast cancer presenting with acute cholecystitis and bacteremia and the unexpected discovery of in peripheral and chemotherapy port blood cultures. After appropriate management and susceptibility testing, the patient fortunately recovered with initial cefepime and eventual levofloxacin to target the species. To our knowledge, this is the third documented case worldwide of isolated from cholecystitis with associated bacteremia and the first documented case in North America. Of special interest, a few months after her infection, the patient was found to be free of breast cancer. species are known to contain levan, an exopolysaccharide, that has been seen to upregulate tumor suppressor genes. This should be considered in the future management and research of infections.
PubMed: 38516448
DOI: 10.7759/cureus.54549 -
Radiology Case Reports Jun 2024The pseudoaneurysms of the cystic artery (CAP) are very uncommon. They usually develop as a result of an acute cholecystitis or after a cholecystectomy. Among the...
The pseudoaneurysms of the cystic artery (CAP) are very uncommon. They usually develop as a result of an acute cholecystitis or after a cholecystectomy. Among the complications, we can find hemorrhaging, biliary blockage, and haemobilia. Limited understanding of the illness makes managing specific cases difficult. We describe a case of a cystic artery pseudoaneurysm complicating an acute cholecystitis that was successfully treated by transcatheter arterial embolization.
PubMed: 38515769
DOI: 10.1016/j.radcr.2024.02.049 -
World Journal of Emergency Surgery :... Mar 2024A textbook outcome patient is one in which the operative course passes uneventful, without complications, readmission or mortality. There is a lack of publications in... (Observational Study)
Observational Study
INTRODUCTION
A textbook outcome patient is one in which the operative course passes uneventful, without complications, readmission or mortality. There is a lack of publications in terms of TO on acute cholecystitis.
OBJETIVE
The objective of this study is to analyze the achievement of TO in patients with urgent early cholecystectomy (UEC) for Acute Cholecystitis. and to identify which factors are related to achieving TO.
MATERIALS AND METHODS
This is a post hoc study of the SPRiMACC study. It´s a prospective multicenter observational study run by WSES. The criteria to define TO in urgent early cholecystectomy (TOUEC) were no 30-day mortality, no 30-day postoperative complications, no readmission within 30 days, and hospital stay ≤ 7 days (75th percentile), and full laparoscopic surgery. Patients who met all these conditions were taken as presenting a TOUEC.
OUTCOMES
1246 urgent early cholecystectomies for ACC were included. In all, 789 patients (63.3%) achieved all TOUEC parameters, while 457 (36.6%) failed to achieve one or more parameters and were considered non-TOUEC. The patients who achieved TOUEC were younger had significantly lower scores on all the risk scales analyzed. In the serological tests, TOUEC patients had lower values for in a lot of variables than non-TOUEC patients. The TOUEC group had lower rates of complicated cholecystitis. Considering operative time, a shorter duration was also associated with a higher probability of reaching TOUEC.
CONCLUSION
Knowledge of the factors that influence the TOUEC can allow us to improve our results in terms of textbook outcome.
Topics: Humans; Cholecystectomy, Laparoscopic; Prospective Studies; Cholecystectomy; Cholecystitis, Acute; Cholecystitis
PubMed: 38515141
DOI: 10.1186/s13017-024-00539-6 -
Ochsner Journal 2024Acute calculous cholecystitis is the obstruction of the cystic duct by a gallstone that leads to inflammation of the gallbladder necessitating cholecystectomy. We...
Acute calculous cholecystitis is the obstruction of the cystic duct by a gallstone that leads to inflammation of the gallbladder necessitating cholecystectomy. We present the cases of 2 patients with acute calculous cholecystitis who were deemed ineligible candidates for cholecystectomy because of their complicating medical histories. Both patients initially underwent cholecystostomy and drain placement with interventional radiology for management of acute calculous cholecystitis. Their large gallstones remained refractory to attempts at removal by electrohydraulic lithotripsy via the cholecystostomy access. The patients' gallstones were successfully removed via percutaneous ultrasonic lithotripsy during a collaborative procedure with interventional radiology and urology. An interdisciplinary approach using percutaneous cholecystolithotomy with rigid ultrasonic lithotripsy is an effective method for removing challenging gallstones in patients for whom traditional approaches fail.
PubMed: 38510219
DOI: 10.31486/toj.23.0071 -
Cureus Feb 2024Background Robotic-assisted surgery continues to grow in popularity. Access during evenings and weekends for non-elective operations can be restricted out of safety...
Background Robotic-assisted surgery continues to grow in popularity. Access during evenings and weekends for non-elective operations can be restricted out of safety concerns. We sought to analyze and compare outcomes of patients undergoing robotic cholecystectomy, a common urgent procedure for acute calculous cholecystitis, during regular hours versus evenings or weekends. Based on this comparison, we sought to determine if this restriction is justified. Methods We performed a retrospective analysis of 46 patients who underwent robotic cholecystectomy for acute calculous cholecystitis per 2018 Tokyo criteria by a single surgeon at a single institution between 2021 and 2022. Patients were grouped as undergoing "after-hours" cholecystectomy if the operation started at five pm or later, or anytime during the weekend (Saturday, Sunday). Demographic, perioperative, and outcome variables were tabulated and analyzed. For illustrative purposes, the data presented as median ± standard deviation were applicable. Results After-hours cholecystectomy occurred in 26 patients and regular-hours cholecystectomy occurred in 20 patients. There were no significant differences in perioperative variables between the two cohorts in terms of body mass index, age, gender, cirrhotic status, American Society of Anesthesiology score, white blood cell count, or neutrophil percentage. The after-hours group had more prior abdominal operations. There were no significant differences between the two groups in terms of operative time, estimated blood loss, or length of stay. There were no mortalities. There was one readmission in the after-hours cohort unrelated to the operation. Conclusion Robotic cholecystectomy can be safely performed on the weekends and evenings. Hospitals should make the robotic platform available during this time.
PubMed: 38505428
DOI: 10.7759/cureus.54413 -
Cureus Feb 2024Introduction Acute cholecystitis (AC), inflammation of the gall bladder, is one of the most common emergency surgical presentations. In the UK, approximately 15% of the...
Outcomes of Percutaneous Image-Guided and Laparoscopic Cholecystostomies in High-Risk Patients With Acute Calculus Cholecystitis: A Five-Year District General Hospital Experience.
Introduction Acute cholecystitis (AC), inflammation of the gall bladder, is one of the most common emergency surgical presentations. In the UK, approximately 15% of the population is estimated to have gallstones, and approximately 20% of them can develop AC. Laparoscopic cholecystectomy (LC) is considered the definitive management of AC. However, cholecystectomy carries a very high risk of morbidity and mortality in high-risk frail patients with multiple comorbidities who are deemed unfit for surgery. Percutaneous cholecystostomy (PC), both image-guided and laparoscopic, is generally acknowledged as an interim treatment measure before definitive management, which is the LC. Materials and methods This is a retrospective study from the Royal Albert Edward Infirmary, a district general hospital (DGH) based in Wigan, UK. The medical records of all the patients who were admitted to the surgical department and underwent PC between January 2017 and December 2022 were analyzed. Patients with previous hepato-pancreato-biliary (HPB) malignancy, who underwent open cholecystostomy, or those with abdominal ascites were excluded from the study. Information was collected regarding the age, gender, American Society of Anaesthesiologists (ASA) grades, success rates of both procedures as temporary or definitive management, duration of hospital stay, 30-day and 1-year mortality after the procedure, timing of the procedure, and long-term complications after the procedure, particularly those related to cholecystostomy tube dislodgment or blockage. Results Twenty-seven patients who underwent PC were divided into two groups: group A, consisting of 10 patients who underwent laparoscopic cholecystostomies, and group B, consisting of 17 patients who had ultrasound (US)-guided cholecystostomies. The mean age of the patients in group A was 66.7 as compared to 75.1 in group B. Most of the patients were in ASA groups III (14) and IV (10). About 74% of patients had procedures done during the day and 26% had PC at night time. The mean hospital stay was 13.5 days. About 55% of patients had planned elective LC as a definitive management. Following the treatment, two patients died within 30 days, and eight patients passed away within a year. About 40% of the patients had complications related to the tube dislodgment and blockage. Conclusion This study concludes that PC, using both laparoscopic and US-guided techniques, can serve as an interim as well as a definitive measure, particularly in patients who are at high risk for anesthesia and the procedure itself and have multiple comorbidities.
PubMed: 38496145
DOI: 10.7759/cureus.54313 -
Journal of Surgical Case Reports Mar 2024An unusual manifestation caused by cholecystitis, infection, or iatrogenic damage after cholecystectomy is a pseudoaneurysm of the cystic artery. We report this rare...
An unusual manifestation caused by cholecystitis, infection, or iatrogenic damage after cholecystectomy is a pseudoaneurysm of the cystic artery. We report this rare illness in a 64-year-old man who visited the emergency room with hematemesis and anemia. The patient initially experienced acute cholecystitis and then underwent a laparoscopic cholecystectomy following which he developed a cystic artery pseudoaneurysm, secondary to infected fluid collection. Based on the patient's history and contrast-enhanced computer tomography abdomen, a diagnosis of pseudoaneurysm of the cystic artery was made. Angioembolization of the hepatic artery branch was performed to occlude the pseudoaneurysm.
PubMed: 38495041
DOI: 10.1093/jscr/rjae152