RESUMO
BACKGROUND: Gallbladder perforation (GBP) is a rare but life-threatening complication of acute cholecystitis. Despite advancements in imaging technology and biochemical analysis, perforations are still diagnosed intraoperatively in some cases. This situation has revealed the need for new markers in the diagnosis of perforation. In this study, we aimed to analyze the role of biomarkers in the diagnosis of perforated cholecystitis cases. METHODS: In this retrospective study, blood samples (white blood cells (WBC), hemoglobin, platelet count, C-reactive protein (CRP), albumin, CRP/albumin ratio (CAR), neutrophil-lymphocyte ratio (NLR), urea, creatinine, glucose, amylase, lipase, aspartate ami-notransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), total bilirubin, direct bilirubin) were analyzed in patients who were diagnosed with acute cholecystitis in the emergency department. RESULTS: One hundred seventy patients were divided into two groups according to the presence or absence of gallbladder perforation. Sixty-three (37.1%) patients had perforation. Transition from laparoscopy to open operation, intensive care unit admission, length of hospital stay, and mortality were higher in the perforated group compared to the non-perforated group. When we analyzed the patients according to laboratory findings, there was a difference in WBC, NLR, CRP, albumin, and CAR parameters in the perforation group. In regression analysis, CRP and CAR performed better. CONCLUSION: Our study showed that CRP and CAR may be diagnostic biomarkers with low specificity and sensitivity in predicting GBP in patients with acute cholecystitis. This marker is a low-cost and easily accessible parameter that may help clinicians make an early diagnosis and plan appropriate treatment for this condition with high morbidity and mortality.
Assuntos
Biomarcadores , Proteína C-Reativa , Humanos , Biomarcadores/sangue , Proteína C-Reativa/análise , Feminino , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Adulto , Colecistite Aguda/sangue , Colecistite Aguda/diagnóstico , Colecistite Aguda/cirurgia , Vesícula Biliar/cirurgia , Vesícula Biliar/patologia , Valor Preditivo dos Testes , Albumina Sérica/análiseRESUMO
RATIONALE: Biliary system anomalies, such as duplicated gallbladders, are rare congenital conditions that present significant diagnostic challenges. Dr. Boyden's classification system, especially the H-type anomaly, offers vital insight into these variations. Failure to detect these anomalies preoperatively can increase the risk of surgical complications, making early identification crucial for surgical planning. PATIENT CONCERN: A 42-year-old male, asymptomatic, was incidentally found to have a gallbladder mass during routine imaging. An upper abdominal magnetic resonance imaging showed gallbladder wall thickening, gallstones, and a liver lesion. Despite the absence of symptoms, a laparoscopic cholecystectomy revealed an atrophied gallbladder with a cystic duct cyst, which was identified as an H-type double gallbladder anomaly. The surgery was completed without complications, and pathology confirmed the presence of gallstones and inflammation. DIAGNOSES: The patient was diagnosed with a duplicated gallbladder, classified as an H-type anomaly, following laparoscopic cholecystectomy. Preoperative imaging identified gallbladder wall thickening and gallstones, and further investigation during surgery confirmed the congenital anomaly. INTERVENTIONS: The patient underwent laparoscopic cholecystectomy for the removal of the gallbladder, and during the procedure, an H-type double gallbladder anomaly was discovered. The surgery proceeded without incident, ensuring the complete excision of the gallbladders. OUTCOMES: The case highlights the diagnostic difficulty of identifying duplicated gallbladders and the importance of advanced imaging techniques in detecting atypical anatomical variations. The successful laparoscopic removal of both gallbladders illustrates the current capabilities of minimally invasive surgery. Postoperative recovery was uneventful, and the pathology confirmed gallstones and inflammation. LESSONS: This case emphasizes the importance of recognizing biliary anomalies such as duplicated gallbladders to avoid complications during surgery. Preoperative identification, aided by imaging, and careful surgical planning are key to managing these rare conditions. The case contributes to the growing body of knowledge about biliary system anomalies and reinforces the need for comprehensive management strategies to ensure optimal patient outcomes.
Assuntos
Colecistectomia Laparoscópica , Vesícula Biliar , Humanos , Masculino , Vesícula Biliar/anormalidades , Vesícula Biliar/cirurgia , Vesícula Biliar/diagnóstico por imagem , Adulto , Colecistectomia Laparoscópica/métodos , Imageamento por Ressonância Magnética , Achados IncidentaisRESUMO
Gallbladder polyp is a common disease of gallbladder, the incidence of gallbladder polyp in China is about 5%~10%, and the trend is increasing year by year. The patients with gallbladder polyps had no obvious clinical symptoms, which was more than that found by ultrasonography during physical examination. At present, the diameter of gallbladder polyps>10 mm is still used by clinicians as the main surgical indication for cholecystectomy. According to the data, about 80% to 90% of gallbladder polyps are cholesterol type polyps and benign gallbladder polyps. For these patients whose gallbladder is removed due to benign gallbladder polyps, we consider that we can continue to observe or retain the gallbladder, without having to bear the adverse consequences that may be caused by gallbladder removal. Based on the literature analysis at home and abroad, this paper discusses the surgical treatment of gallbladder polyps and the results of postoperative pathological diagnosis, and reminds the majority of clinicians to be careful when removing gallbladder polyps.
Assuntos
Colecistectomia , Doenças da Vesícula Biliar , Pólipos , Humanos , Pólipos/cirurgia , Doenças da Vesícula Biliar/cirurgia , Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/cirurgiaRESUMO
INTRODUCTION: Bile acid diarrhoea (BAD) can occur due to disruption to the enterohepatic circulation such as following cholecystectomy. However, the mechanism behind this is as yet unknown. The aim of this study was to determine the rate of post-cholecystectomy diarrhoea and to assess whether FGF19 within the gallbladder was associated with the development of BAD. METHODS: This was a prospective case-control study in which patients were assessed pre- and post- cholecystectomy (study group) and compared with patients also having laparoscopic surgery but not cholecystectomy (control group). Their bowel habits and a GIQLI questionnaire was performed to compare the pre- and post-operative condition of the two groups. Gallbladder tissue sample was tested for FGF19 and PPARα in the study group patients. A subset had serum lipid levels, FGF19 and C4 measurements. RESULTS: Gallbladder PPAR α was found to have a significant correlation with stool consistency, with the lower the PPARα concentration the higher the Bristol stool chart number (i.e. looser stool). There were no significant correlation when assessing the effect of gallbladder FGF19 concentration on bowel habit, stool consistency, lipid levels, BMI or smoking. The study group showed a significant increase in triglycerides post-operatively, however there were no changes in cholesterol, HDL and LDL levels. Correlation of the increased triglyceride levels with stool consistency and frequency showed no significant results DISCUSSION AND CONCLUSION: We did not find any direct evidence that FGF19 levels within the gallbladder impact the development of post-cholecystectomy diarrhoea. There was however a significant increase in triglycerides postoperatively. There was also no correlation of bowel habits with PPARα suggesting the observed rise is independent of this pathway. Further work is required particularly relating to the gut microbiome to further investigate this condition.
Assuntos
Ácidos e Sais Biliares , Diarreia , Fatores de Crescimento de Fibroblastos , PPAR alfa , Humanos , Estudos de Casos e Controles , Diarreia/etiologia , Diarreia/metabolismo , Estudos Prospectivos , Ácidos e Sais Biliares/sangue , Ácidos e Sais Biliares/metabolismo , Feminino , Masculino , Pessoa de Meia-Idade , Fatores de Crescimento de Fibroblastos/sangue , Fatores de Crescimento de Fibroblastos/metabolismo , PPAR alfa/metabolismo , Adulto , Triglicerídeos/sangue , Colecistectomia/efeitos adversos , Vesícula Biliar/metabolismo , Vesícula Biliar/cirurgia , Complicações Pós-Operatórias/etiologia , Circulação Êntero-Hepática , Idoso , Colestenonas/sangueRESUMO
The relationship between Helicobacter pylori infection and gallbladder diseases, particularly cholecystitis and gallbladder polyps, remains unclear. This study aimed to investigate the presence of H. pylori in gallbladder tissues and its potential role in gallbladder pathologies, as well as to examine the expression of chemokines CXCL2 and CXCL5 in these conditions. MATERIAL AND METHODS: A total of 137 laparoscopically excised gallbladders were analysed through histological examination, PCR for H. pylori-specific DNA, and quantitative real-time PCR for CXCL2 and CXCL5 gene expression. The study cohort included patients with acute calculous cholecystitis, chronic calculous cholecystitis, and gallbladder polyps. RESULTS: H. pylori was detected in 30.7% of cases by histological methods and 42.3% by PCR. Elevated expression of CXCL2 and CXCL5 was observed in 62% and 57.7% of cases, respectively, with a higher prevalence in acute cholecystitis compared to chronic conditions. However, no statistically significant association was found between H. pylori presence and the forms of cholecystitis, as well as between H. pylori presence and chemokine expression in gallbladder. CONCLUSIONS: The study did not establish a direct link between the presence of H. pylori infection and forms of gallbladder pathologies. The findings suggest that other factors other than H. pylori may contribute to the upregulation of CXCL2 and CXCL5 in gallbladder diseases. Further research is needed to elucidate the complex interactions between H. pylori, chemokines, and gallbladder pathologies.
Assuntos
Quimiocina CXCL2 , Quimiocina CXCL5 , Vesícula Biliar , Infecções por Helicobacter , Helicobacter pylori , Humanos , Helicobacter pylori/isolamento & purificação , Helicobacter pylori/patogenicidade , Infecções por Helicobacter/microbiologia , Infecções por Helicobacter/patologia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/genética , Masculino , Vesícula Biliar/microbiologia , Vesícula Biliar/patologia , Vesícula Biliar/cirurgia , Feminino , Pessoa de Meia-Idade , Quimiocina CXCL5/genética , Quimiocina CXCL5/metabolismo , Quimiocina CXCL2/genética , Quimiocina CXCL2/metabolismo , Adulto , Colecistite/microbiologia , Colecistite/patologia , Colecistite/cirurgia , Pólipos/microbiologia , Pólipos/patologia , Doenças da Vesícula Biliar/microbiologia , Doenças da Vesícula Biliar/patologia , Doenças da Vesícula Biliar/cirurgia , IdosoRESUMO
Laparoscopic cholecystectomy is one of the most frequently performed operations by general surgeons, with up to 1 million cholecystectomies performed annually in the United States alone. Despite familiarity, common bile duct injury occurs in no less than 0.2% of cholecystectomies, with significant associated morbidity. Understanding biliary anatomy, surgical techniques, pitfalls, and bailout maneuvers is critical to optimizing outcomes when encountering the horrible gallbladder. This article describes normal and aberrant biliary anatomy, complicated cholelithiasis, ways to recognize cholecystitis, and considerations of surgical approach.
Assuntos
Colecistectomia Laparoscópica , Vesícula Biliar , Humanos , Colecistectomia Laparoscópica/métodos , Vesícula Biliar/cirurgia , Colelitíase/cirurgiaRESUMO
We present gallbladder rupture following trauma. A 9-year-old boy admitted in 1.5 hours after injury. Considering clinical and ultrasound data, we diagnosed traumatic damage to the spleen and hemoperitoneum, biliary dyskinesia, cholestasis, sludge. Hemostatic therapy was carried out. After 3 days, signs of peritonitis appeared. Follow-up ultrasound revealed gallbladder enlargement with heterogeneous content, fluid in all parts of abdominal cavity. Intraoperatively, the gallbladder was enveloped in omentum soaked in bile. After mobilization of the gallbladder, we found longitudinal linear tear up to 3 cm clogged with omentum. Cholecystectomy was performed. Thus, we present a patient with combined injury and damage to the spleen. However, gallbladder wall thickening and heterogeneous content were interpreted as concomitant pathology. Delayed manifestation of peritonitis was due to gallbladder enveloped in omentum. The last one soaked in bile partially entered the gallbladder through perforation and prevented bile leakage into abdominal cavity. Timely diagnosis of gallbladder damage presents certain difficulties, especially in case of combined injury. Ultrasound signs of traumatic gallbladder rupture in this case were wall thickening, heterogeneous content and gradual gallbladder enlargement. It is necessary to analyze all organs at the damage site including computed tomography in patients with combined trauma.
Assuntos
Colecistectomia , Vesícula Biliar , Ultrassonografia , Humanos , Masculino , Criança , Vesícula Biliar/lesões , Vesícula Biliar/cirurgia , Colecistectomia/métodos , Ruptura , Ultrassonografia/métodos , Traumatismos Abdominais/complicações , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgia , Resultado do Tratamento , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/cirurgia , Baço/lesões , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/diagnóstico , Peritonite/etiologia , Peritonite/diagnóstico , Peritonite/cirurgiaRESUMO
BACKGROUND: Gallbladder perforations are challenging to manage for surgeons due to their high morbidity and mortality, rarity, and surgical approach. Laparoscopic cholecystectomy (LC) is now included with open cholecystectomy in surgical managing gallbladder perforations. This study aimed to evaluate the factors affecting conversion from laparoscopic to open cholecystectomy in cases of type I gallbladder perforation according to the Modified Niemeier classification. METHODS: Patients who met the inclusion criteria were divided into two groups: LC and conversion to open cholecystectomy (COC). Demographic, clinical, radiologic, intraoperative, and postoperative factors were compared between groups. RESULTS: This study included 42 patients who met the inclusion criteria, of which 28 were in the LC group and 14 were in the COC group. Their median age was 68 (55-85) years. Age did not differ significantly between groups (p = 0.218). However, the sex distribution did differ significantly between groups (p = 0.025). The location of the perforation differed significantly between groups (p < 0.001). In the LC group, 22 patients were perforated from the fundus, four from the trunk, and two from the neck. In the COC group, two patients were perforated from the fundus, four from the trunk, and eight from the neck. Surgical procedure times differed significantly between the LC (105.0 min [60-225]) and COC (125.0 min [110-180]) groups (p = 0.035). The age of the primary surgeons also differed significantly between the LC (42 years [34-63]) and COC (55 years [36-59]) groups (p = 0.001). CONCLUSIONS: LC can be safely performed for modified Niemeier type I gallbladder perforations. The proximity of the perforation site to Calot's triangle, Charlson comorbidity index (CCI), and Tokyo classification are factors affecting conversion from laparoscopic to open surgery of gallbladder perforations.
Assuntos
Colecistectomia Laparoscópica , Doenças da Vesícula Biliar , Humanos , Masculino , Idoso , Feminino , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Colecistectomia Laparoscópica/métodos , Colecistectomia Laparoscópica/efeitos adversos , Doenças da Vesícula Biliar/cirurgia , Estudos Retrospectivos , Conversão para Cirurgia Aberta/estatística & dados numéricos , Emergências , Colecistectomia/métodos , Vesícula Biliar/cirurgia , Vesícula Biliar/lesões , Resultado do TratamentoRESUMO
SummarySquamous cell carcinoma (SCC) is an uncommon and frequently aggressive subtype of gallbladder cancer known for its poor outcomes compared with other gallbladder tumours. Gallbladder SCC typically presents as higher grade and more advanced than adenocarcinoma, resulting in lower estimated survival. Early recognition of these tumours is ideal, but infrequently achieved. Herein is a case of a male patient in his 80s with new onset abdominal pain who was initially diagnosed with cholecystitis, but diagnostic imaging revealed a gallbladder mass. Surgical resection and pathology revealed pure SCC of the gallbladder without local organ invasion or metastatic disease. Pure SCC histology of the gallbladder is rare, with limited studies on clinical presentation, natural history, and optimal treatment.
Assuntos
Carcinoma de Células Escamosas , Neoplasias da Vesícula Biliar , Humanos , Masculino , Neoplasias da Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/diagnóstico , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Tomografia Computadorizada por Raios X , Vesícula Biliar/patologia , Vesícula Biliar/cirurgia , Vesícula Biliar/diagnóstico por imagem , ColecistectomiaRESUMO
ABSTRACT: Gallbladder torsion is a rare cause of acute surgical abdomen. Early recognition and surgical intervention are important for reducing complications and improving postoperative patient outcomes, but standard imaging and laboratory evaluation typically are indistinguishable from those of acute cholecystitis. This article describes a patient with gangrenous cholecystitis secondary to torsion and summarizes recommendations for evaluation and management.
Assuntos
Doenças da Vesícula Biliar , Gangrena , Anormalidade Torcional , Humanos , Anormalidade Torcional/cirurgia , Anormalidade Torcional/diagnóstico , Doenças da Vesícula Biliar/cirurgia , Doenças da Vesícula Biliar/diagnóstico , Gangrena/etiologia , Gangrena/cirurgia , Vesícula Biliar/cirurgia , Vesícula Biliar/diagnóstico por imagem , Feminino , Colecistite/cirurgia , Colecistite/diagnóstico , Colecistite/etiologia , Masculino , Abdome Agudo/etiologia , Tomografia Computadorizada por Raios XRESUMO
Niemeier type II gallbladder perforation (GBP) is caused by inflammation and necrosis of the gallbladder wall followed by bile spilling into the abdominal cavity after perforation. The gallbladder then becomes adhered to the surrounding inflammatory tissue to form a purulent envelope, which communicates with the gallbladder. At present, the clinical characteristics and treatment of type II GBP are not well understood and management of GBP remains controversial. Type II GBP with gastric outlet obstruction is rare and prone to misdiagnosis and delayed treatment. Recent systematic reviews report that percutaneous drainage does not influence outcomes. In this current case, due to the high risk of bleeding and accidental injury, as well as a lack of access to safely visualize the Calot's triangle, the patient could not undergo laparoscopic cholecystectomy, which would have been the ideal option. This current case report presents the use of percutaneous laparoscopic drainage combined with percutaneous transhepatic gallbladder drainage in a patient with type II GBP associated with gastric outlet obstruction. A review of the relevant literature has been provided in addition to a summary of the clinical manifestations and treatments for type II GBP.
Assuntos
Drenagem , Vesícula Biliar , Humanos , Vesícula Biliar/cirurgia , Vesícula Biliar/patologia , Vesícula Biliar/diagnóstico por imagem , Drenagem/métodos , Doenças da Vesícula Biliar/cirurgia , Doenças da Vesícula Biliar/patologia , Doenças da Vesícula Biliar/diagnóstico , Doenças da Vesícula Biliar/diagnóstico por imagem , Masculino , Feminino , Obstrução da Saída Gástrica/cirurgia , Obstrução da Saída Gástrica/etiologia , Obstrução da Saída Gástrica/diagnóstico , Laparoscopia , Tomografia Computadorizada por Raios X , Colecistectomia Laparoscópica/efeitos adversos , Pessoa de Meia-IdadeRESUMO
This study retrospectively evaluated the outcomes of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using novel electrocautery-enhanced lumen-apposing metal stents (LAMS) in high-risk patients with acute cholecystitis (AC). Between January 1, 2021, and November 30, 2022, 58 high-risk surgical patients with AC underwent EUS-GBD with the novel electrocautery-enhanced LAMS. The technical success rate was 94.8% (55/58), with one case of duodenal perforation requiring surgery with complete stent migration and two of partial stent migration into the gallbladder. However, the clinical success rate was 100% (55/55). Recurrent AC occurred in 3.6% of the cases (2/55), managed with double pigtail plastic stents through the LAMS. Early AEs observed in 1.8% (1/55) due to stent obstruction. Late AEs occurred in 5.4% (3/55), including two cases of cholangitis and one of stent obstruction. For 33 patients followed over 6 months, LAMS maintenance was sustained in 30 cases. Two patients underwent double-pigtail plastic stent replacement after LAMS removal, and one underwent LAMS removal during surgery following tumor stage regression after chemotherapy for cholangiocarcinoma. The novel electrocautery-enhanced LAMS demonstrated high technical and clinical success rates in high-risk surgical patients with AC, maintaining effective gallbladder drainage with minimal AEs during long-term follow-up, thus highlighting its efficacy and safety in challenging patients.
Assuntos
Drenagem , Eletrocoagulação , Endossonografia , Vesícula Biliar , Stents , Humanos , Masculino , Feminino , Drenagem/métodos , Idoso , Eletrocoagulação/métodos , Endossonografia/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Vesícula Biliar/cirurgia , Idoso de 80 Anos ou mais , Resultado do Tratamento , Colecistite Aguda/cirurgia , AdultoRESUMO
PURPOSE: Ventriculo-peritoneal shunt is the gold standard for non-obstructive hydrocephalus. Despite advances in material, infection prevention, and valve technologies, failure can still occur. The aim of this article is to present a comprehensive study based on the experience of a reference center in pediatric neurosurgery in Rio de Janeiro with the use of the ventriculo-gallbladder shunt as an alternative to peritoneal failure. METHODS: A retrospective study was conducted from January 2018 to December 2023 of patients diagnosed with cerebrospinal fluid shunt dysfunction due to peritoneal failure and submitted to ventriculo-gallbladder shunt as an alternative in a reference center of Rio de Janeiro. RESULTS: From 2018 to 2023, 18 peritoneal failures were diagnosed. Among them, 10 patients (55.5%) were selected for ventriculo-gallbladder shunt (VGS). Different causes were responsible for the hydrocephalus in these patients. VGS was placed at a mean age of 35.4 months. Four patients had temporary complications: 2 self-limited diarrheas in the first month and 2 shunt infections. After the resolution of the infection, a new VGS was placed successfully. The average follow-up was 18.8 months (follow-up 9-68 months) without further issues. CONCLUSION: VGS is a viable option for patients facing peritoneal failure. This paper provides valuable insights into the surgical technique and outcomes associated with this alternative.
Assuntos
Derivações do Líquido Cefalorraquidiano , Vesícula Biliar , Hidrocefalia , Humanos , Pré-Escolar , Hidrocefalia/cirurgia , Estudos Retrospectivos , Feminino , Masculino , Lactente , Criança , Vesícula Biliar/cirurgia , Derivações do Líquido Cefalorraquidiano/métodos , Derivações do Líquido Cefalorraquidiano/efeitos adversos , Derivação Ventriculoperitoneal/métodos , Derivação Ventriculoperitoneal/efeitos adversosRESUMO
Cholecystectomy is indicated for gallbladder mucoceles (GBM). Evaluating the patency of the biliary duct and precise biliary tree visualization is crucial for reducing the risk of compromised bile flow after surgery. Therefore, intraoperative cholangiography (IOC) is recommended during cholecystectomy to prevent biliary tract injury. Although indocyanine green (ICG) cholangiography has been extensively reported in human medicine, only one study has been conducted in veterinary medicine. Therefore, this study aimed to demonstrate the use of ICG for IOC to identify fluorescent biliary tract images and determine the patency of the common bile duct during cholecystectomy in dogs. This study comprised 27 dogs, consisting of 17 with gallbladder mucoceles (GBM) and 10 controls, specifically including dogs that had undergone elective cholecystectomy for GBM. ICG injection (0.25 mg/kg) was administered intravenously at least 45 minutes before surgery. During the operation, fluorescent images from cholangiography were displayed on the monitor and obtained in black-and-white mode for the comparison of fluorescence intensity (FI). The FI values of the gallbladders (GBs) and common bile duct (CBD) were measured using FI analyzing software (MGViewer V1.1.1, MetapleBio Inc.). The results demonstrated successful CBD patency identification in all cases. Mobile GBM showed partial gallbladder visibility, whereas immobile GBM showed limited visibility. Additionally, insights into the adequate visualization of the remaining extrahepatic biliary tree anatomy were provided, extending beyond the assessment of CBD patency and gallbladder intensity. Our study demonstrates the potential of fluorescent IOC using intravenous injection of ICG for assessing the patency of the cystic duct and common bile duct during cholecystectomy in patients with GBM, eliminating the need for surgical catheterization and flushing of the biliary ducts. Further research is warranted to investigate and validate the broader applicability of ICG cholangiography in veterinary medicine.
Assuntos
Colangiografia , Doenças do Cão , Verde de Indocianina , Mucocele , Animais , Cães , Colangiografia/métodos , Mucocele/diagnóstico por imagem , Mucocele/cirurgia , Doenças do Cão/diagnóstico por imagem , Doenças do Cão/cirurgia , Masculino , Feminino , Sistema Biliar/diagnóstico por imagem , Sistema Biliar/patologia , Doenças da Vesícula Biliar/diagnóstico por imagem , Doenças da Vesícula Biliar/cirurgia , Doenças da Vesícula Biliar/veterinária , Colecistectomia , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Vesícula Biliar/patologiaRESUMO
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has emerged as a popular alternative to percutaneous cholecystostomy and endoscopic transpapillary gallbladder drainage for patients suffering from acute calculous cholecystitis who are at high risk for surgery. Multiple cohorts, meta-analyses, and a randomized controlled trial have shown that EUS-GBD has lower rates of recurrent cholecystitis and unplanned reinterventions, while achieving similar technical and clinical success rates than transpapillary cystic duct stenting. The essential steps, precautions in performing EUS-GBD and long-term management will be discussed in this article.
Assuntos
Drenagem , Endossonografia , Ultrassonografia de Intervenção , Humanos , Drenagem/métodos , Endossonografia/métodos , Ultrassonografia de Intervenção/métodos , Colecistite Aguda/cirurgia , Vesícula Biliar/cirurgia , Vesícula Biliar/diagnóstico por imagemRESUMO
Gall bladder diaphragm is a rare congenital malformation of the gall bladder, entailing its segmentation in several chambers. Functioning as a non-return valve, it interferes with drainage, leading to gallstone formation and cholecystitis. We are reporting a rare case of acute cholecystitis with a double vesicular diaphragm.
Assuntos
Colecistite Aguda , Vesícula Biliar , Humanos , Vesícula Biliar/anormalidades , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Colecistite Aguda/cirurgia , Feminino , Masculino , Tomografia Computadorizada por Raios XRESUMO
Left-sided gallbladder positioning, or sinistroposition, is a rare anatomical variation that poses challenges during surgical intervention due to associated vascular and biliary anomalies. While existing literature suggests an incidence of approximately 0.04-1.1%, it remains an underreported phenomenon that falls well outside the realm of "expected" anatomical variation and are rarely identified on preoperative imaging. Here, we present a case of acute cholecystitis in a patient with unexpected left-sided gallbladder, highlighting the associated challenges and outlining both preoperative and intraoperative strategies for managing this rare but consequential anatomical variant. In this case, a 49-year-old woman with a prior history of bilateral ovarian cysts presented with clinical, laboratory, and imaging findings consistent with acute cholecystitis. She underwent laparoscopic cholecystectomy and was found to have a severely inflamed left-sided gallbladder that was obscured by omentum. Her gallbladder was found in the midline immediately beneath the falciform ligament, with most of the gallbladder body and fundus attached to liver segment III, situated to the left of the midline. An additional left-sided mid-abdominal port was required to enhance retraction, and an intraoperative cholangiogram (IOC) was performed given the elevated risk of structural injury. This case underscores the heightened intraoperative risk associated with deviations in vascular and biliary anatomy and provides recommendations for intraoperative adaptations to mitigate these risks.