Acute acalculous cholecystitis

Acute acalculous cholecystitis is now well recognised but is almost certainly not an homogeneous entity. The recognition of at least two sub-groups would appear to enhance the clinical perspective of this problem and facilitate on-going study and discussion. Two cases representing one of these sub-sets are reported, and both varieties are described. (AU)

Empyema of gall bladder in a child with homozygous sickle-cell disease

A 13-year-old boy with homozygous sickle-cell (SS) disease followed from birth in a cohort study of sickle-cell disease developed empyema of the gallbladder after a known 3-year history of gallstones. At this age, gallstones occur in 30 percent of cohort study children with SS disease but this is the first patient with specific symptoms (AU)

Prediction of relapse after acute typhoid fever by oral cholecystogram - abstract

Dominica has the highest incidence of typhoid fever in the Caribbean (44/100,000 in 1983) and a high relapse rate of 20 percent. A prospective study was performed from January 1984 to June 1985 on gallbladder function at oral cholecystography and subsequent relapse, in all patients admitted with acute typhoid fever to the medical unit. Twenty-two patients were studied. All had S. typhi isolated from blood or stool that was fully sensitive to chloramphenicol. Each received chloramphenicol (50mg/kg/day) for 3 days followed by 30 mg/kg/day for 11 days. All the cholecystograms were performed within 3 days of completing the antibiotic. If the gallbladder was not visualised a double-dose study was done, and if this was also abnormal, a further study was done after 3 months. The results were as follows: SUBSEQUENT COURSE: Normal gallbladder, Non-visualised gallbladder; RELAPSE: 3, 2 respectively; CONV. CARRIER: 4, 1 respectively; UNCOMPLICATED: 13, 0 respectively; TOTAL 20, 3 respectively. There were no statistically significant differences. However, the 2 cases with non-functioning gallbladders both experienced severe relapses, and were given adjuvant steroid therapy. The others had very mild illnesses. Both severe relapsers had normally functioning gallbladders 3 months later. Overall, the results are consistent with hypothesis that typhoid fever relapse is due to intracellular persistence of S. typhi rather than to gallbladder involvement. But in 2 cases, temporary loss of gallbladder function at oral cholecystography was associated with severe relapse. Oral cholecystogram may thus detect unresolved S. typhi cholecystitis which leads to severe relapse compared with that due to intracellular persistence elsewhere (AU)

Biliary ascariasis

Biliary ascariasis complicated by cholangitis is reported in a 23-year-old woman. Removal of a worm and cholecytostomy were performed. Residual worms were found in the bile ducts by post-operative cholecysto-cholangiography. These were successfully eradicated with oral antihelminthic therapy (AU)

Gall bladder disease at the University Hospital, Jamaica

A review of 250 patients with gall bladder disease seen at the University Hospital in Jamaica is presented. The striking feature is the early age of presentation. It is suggested that this may be related to early and multiple pregnancies in the women. The condition, except in its associated diseases, follows the patterns classically described, and the study also confirms that surgical treatment of acute cholecystitis is safe and to be performed (AU)

An unusual case of traumatic haemobilia

A case of traumatic haemobilia is presented. It is unusual in that it followed a minor penetrating injury with an ice pick, an instrument only slightly larger than a liver biopsy needle. Furthermore the precipitating cause for urgent surgery was an acute cholecystitis, rather than massive haemorrhage. Bleeding ceased after treatment for the infecting organisms, isolated from the gall bladder, following on cholecystectomy and biliary drainage (AU)

Gall bladder disease in Jamaica - abstract

This paper reports a study of cases seen at the University Hospital of the West Indies (U.H.W.I.) to determine the pattern of the disease in Jamaica. The notes were reviewed in regard to age and sex distribution, economic status and build of the patients and the course of the disease. The data are compared with that from North American centres. The results showed that 40 percent of patients were below the age of 40 years and 25 percent below the age of 30 years, as compared with 15 percent and 7 percent respectively from North American Centre. This age distribution was largely unaffected when patients with haemoglobinopathies were excluded. It was confirmed that the disease is one of affluence and overnutrition, in that most patients were obese. In spite of the fact that the vast majority of patients seen at U.H.W.I. are poor - 75 percent of patients with gall bladder disease came from middle and upper income brackets and from the urban areas. Of the poor patients with gall bladder disease 70 percent were domestics. The results of treatment showed that 40 percent of patients treated conservatively for acute cholecystitis required urgent imperative intervention for a variety of reasons. It is concluded that the disease is seen in a large proportion of young patients in Jamaica, that it is a disease of affluence and overnutrition, and that early operative intervention during an attack of acute cholecystitis is the best form of treatment (AU)