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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 -
Medicine May 2024Some observational studies have highlighted a significant association between cholecystitis and factors leading to sudden death; however, the specific relationship... (Meta-Analysis)
Meta-Analysis
Some observational studies have highlighted a significant association between cholecystitis and factors leading to sudden death; however, the specific relationship between the 2 has not been fully elucidated. The primary objective of this study was to elucidate the causal interplay between cholecystitis and augmented risk of sudden cardiac death. We used large-scale genetic summary data from genome-wide association study, genetic summary statistics were sourced from 3 eminent repositories: the UK Biobank (N = 463,010), the FinnGen consortium (N = 215,027), and the European Bioinformatics Institute (N = 471,251). By employing 2-sample Mendelian randomization (MR) to decipher the causal interplay between cholecystitis and sudden death etiologies, a meta-analytical approach was employed to amalgamate the findings derived from these disparate data sources. The primary MR methodologies used included inverse variance weighting with random effects, inverse variance weighting with fixed effects, maximum likelihood, MR-Egger, and weighted median. Subsequently, we performed heterogeneity testing, polyvalency examination, and sensitivity analysis to bolster the robustness of causal relationship assessments. Meta-analysis and amalgamating variegated data sources revealed a statistically significant inverse correlation between cholecystitis and ventricular arrhythmias (odds ratio, 0.896; 95% confidence interval: 0.826-0.971; P = .008). Similarly, an inverse association was observed between cholecystitis and aortic aneurysm (odds ratio, 0.899; 95% confidence interval: 0.851-0.951, P < .001). This study substantiates the absence of a direct causal link between cholecystitis and cerebrovascular accidents (P = .771), pulmonary embolism (P = .071), and acute myocardial infarction (P = .388). A direct causal correlation existed between cholecystitis and sudden death associated with ventricular arrhythmias and aortic aneurysms. The onset of cholecystitis may mitigate the risk of sudden death due to ventricular arrhythmias and aortic aneurysms.
Topics: Humans; Mendelian Randomization Analysis; Death, Sudden, Cardiac; Genome-Wide Association Study; Cholecystitis; Risk Factors
PubMed: 38787985
DOI: 10.1097/MD.0000000000038240 -
Oxford Medical Case Reports May 2024Apocrine metaplasia, specifically, involves the development of cells resembling those in apocrine glands, characterized by their distinctive cytoplasmic features....
Apocrine metaplasia, specifically, involves the development of cells resembling those in apocrine glands, characterized by their distinctive cytoplasmic features. Apocrine metaplasia in the gallbladder represents a new and intriguing discovery, marking a significant milestone in medical literature. Furthermore, clear cell metaplasia is often observed in other organs like the cervix and has never been documented in the gallbladder. The coexistence of apocrine and clear metaplasia challenges existing paradigms surrounding gallbladder pathology, prompting a reevaluation of the underlying mechanisms that drive these cellular transformations.
PubMed: 38784780
DOI: 10.1093/omcr/omae052 -
Cureus Apr 2024This case report discusses the incidental discovery of a cervical rib in a 53-year-old woman presenting with acute cholecystitis. While cervical ribs are rare, their...
This case report discusses the incidental discovery of a cervical rib in a 53-year-old woman presenting with acute cholecystitis. While cervical ribs are rare, their identification holds clinical significance due to their potential implications for vascular compression or thoracic outlet syndrome. Despite the patient's primary complaint of cholecystitis, a chest X-ray incidentally revealed the cervical rib. This finding underscores the importance of a thorough radiographic examination. The report discusses similar cases, emphasizing varying clinical presentations and associated vascular complications. The case highlights the necessity for a comprehensive assessment of incidental findings to ensure holistic patient care and management, emphasizing the importance of considering anatomical variants in clinical practice.
PubMed: 38784324
DOI: 10.7759/cureus.58794 -
European Review For Medical and... May 2024The aim of this prospective, single-center cohort study was to analyze serum leucine-rich α-2-glycoprotein-1 (LRG1) expression in patients with acute cholecystitis (AC)...
OBJECTIVE
The aim of this prospective, single-center cohort study was to analyze serum leucine-rich α-2-glycoprotein-1 (LRG1) expression in patients with acute cholecystitis (AC) and to investigate its variation depending on symptom duration.
PATIENTS AND METHODS
Participants were divided into patients with AC and a healthy control group. At the time of diagnosis, blood samples were collected, and symptom onset times were questioned. Collected serum LRG1 levels were measured.
RESULTS
30 patients and 30 healthy volunteers were included in the study. LRG1 (p=0.008), white blood cells (WBC) (p<0.001), platelet (p=0.003), neutrophil (p<0.001), lymphocyte (p=0.001), and CRP (p=0.014) were significantly different in AC patients vs. the control group. When the correlations of serum laboratory values with the time of onset of symptoms were compared, LRG1 (p<0.001) was significantly correlated, while no significant correlation was observed in C-reactive protein (CRP) (p=0.572), WBC (p=0.155), and neutrophil (p=0.155).
CONCLUSIONS
LRG1 expression increases after 24 hours in AC patients. Due to its correlation with symptom duration, we believe it can be helpful for timing cholecystectomy.
Topics: Humans; Glycoproteins; Male; Prospective Studies; Female; Cholecystitis, Acute; Middle Aged; Adult; C-Reactive Protein; Case-Control Studies; Aged
PubMed: 38766797
DOI: 10.26355/eurrev_202405_36186 -
World Journal of Clinical Cases May 2024Autoimmune pancreatitis (AIP) is a rare form of autoimmune-mediated pancreatitis, which is easily misdiagnosed as pancreatic cancer and thus treated surgically. We...
BACKGROUND
Autoimmune pancreatitis (AIP) is a rare form of autoimmune-mediated pancreatitis, which is easily misdiagnosed as pancreatic cancer and thus treated surgically. We studied the diagnosis and treatment of a patient with type 1 AIP recently admitted to our hospital, and reviewed the literature to provide a reference for clinical diagnosis of AIP.
CASE SUMMARY
The chief complaint was yellowing of the body, eyes and urine for 21 d. The patient's clinical presentation was obstructive jaundice and imaging suggested pancreatic swelling. It was difficult to distinguish between inflammation and tumor. Serum immunoglobulin G4 (IgG4) was markedly elevated. IgG4 is an important serological marker for type 1 AIP. The patient was diagnosed with AIP, IgG4-related cholangitis, acute cholecystitis and hepatic impairment. After applying hormonal therapy, the patient's symptoms improved significantly. At the same time, imaging suggested that pancreatic swelling subsided, and liver function and other biochemical indicators decreased. The treatment was effective.
CONCLUSION
In patients with pancreatic swelling, the possibility of AIP should be considered.
PubMed: 38765756
DOI: 10.12998/wjcc.v12.i14.2438 -
Cureus Apr 2024Introduction Gallstone ileus is an uncommon cause of small bowel obstruction; it is a rare complication of calculus chronic cholecystitis which leads to...
Introduction Gallstone ileus is an uncommon cause of small bowel obstruction; it is a rare complication of calculus chronic cholecystitis which leads to cholecystoenteric fistula and impaction of gallstone in the gastrointestinal tract leading to mechanical bowel obstruction. Our aim is to report the natural history and management of this rare condition in a teaching hospital. Materials and methods It is a retrospective study, where 10 years of data related to the management of intestinal obstruction secondary to gallstone ileus was collected. The cohort included 10 patients, whose demographic data, clinical findings, and management outcomes were evaluated. Results Majority of patients were female (90%, n=9) with a median of 83 years (range 61-96) although 90% of the population were above 70 years. Presenting complaints were mostly pain and vomiting. The onset of symptoms was between two and seven days. The site of obstruction was mostly the ileum (n=9) with the exception of one case in the sigmoid proximal to a benign stricture, and the size of the stone ranged from 2.5 to 4 cm. Moreover, most of the patients had a previous history of gallstone (n=7) with one post-cholecystectomy status. The laboratory investigations in 50% of patients had deranged liver function test (LFT) and acute kidney injury (AKI), and 60% had raised inflammatory markers, namely, white blood cells (WBC) and C-reactive protein (CRP). Intervention as enterolithotomy was the preferred approach (n=8 (two laparoscopic, six open surgery)), and two patients were managed conservatively. The mean postoperative length of stay was 10 days in the open approach and five days in the laparoscopic approach, respectively. Conclusions Elderly female patients are more prone to have gallstone ileus particularly with a past medical history of gallstones, and the preferred management option is enterolithotomy which could be open or laparoscopic depending on the expertise of the surgeon.
PubMed: 38765387
DOI: 10.7759/cureus.58438 -
Clinical Endoscopy May 2024Endoscopic biliary drainage using self-expandable metallic stents (SEMSs) for malignant biliary strictures occasionally induces acute cholecystitis (AC). This study...
Prophylactic endoscopic transpapillary gallbladder stenting to prevent acute cholecystitis induced after metallic stent placement for malignant biliary strictures: a retrospective study, Japan.
BACKGROUND/AIMS
Endoscopic biliary drainage using self-expandable metallic stents (SEMSs) for malignant biliary strictures occasionally induces acute cholecystitis (AC). This study evaluated the efficacy of prophylactic gallbladder stents (GBS) during SEMS placement.
METHODS
Among 158 patients who underwent SEMS placement for malignant biliary strictures between January 2018 and March 2023, 30 patients who attempted to undergo prophylactic GBS placement before SEMS placement were included.
RESULTS
Technical success was achieved in 21 cases (70.0%). The mean diameter of the cystic duct was more significant in the successful cases (6.5 mm vs. 3.7 mm, p<0.05). Adverse events occurred for 7 patients (23.3%: acute pancreatitis in 7; non-obstructive cholangitis in 1; perforation of the cystic duct in 1 with an overlap), all of which improved with conservative treatment. No patients developed AC when the GBS placement was successful, whereas 25 of the 128 patients (19.5%) without a prophylactic GBS developed AC during the median follow-up period of 357 days (p=0.043). In the multivariable analysis, GBS placement was a significant factor in preventing AC (hazard ratio, 0.61; 95% confidence interval, 0.37-0.99; p=0.045).
CONCLUSIONS
GBS may contribute to the prevention of AC after SEMS placement for malignant biliary strictures.
PubMed: 38756066
DOI: 10.5946/ce.2023.284