The risk and predictors of gallbladder cancer in patients with gallbladder polyps: A retrospective cohort study with an insight into confounding by indication.

BACKGROUND AND AIM: We aimed to determine the risk and predictors of gallbladder cancer in all individuals with gallbladder polyps (GP) including those who did not have cholecystectomy. METHODS: The STROCSS guideline was followed to conduct a retrospective cohort study. All individuals with GP between 2010 and 2019 were followed up to determine the risk and predictors of gallbladder cancer. The primary outcomes were gallbladder cancer and gallbladder dysplasia, and the secondary outcomes included polyp growth rate and polyp disappearance rate. Binary logistic regression analysis and receiver operating characteristic curve analysis were conducted to evaluate the outcomes. RESULTS: Analysis of 438 patients showed risk of gallbladder cancer was 0.7% in all polyps (0% in polyps < 10 mm; 5.9% in polyps ≥ 10 mm). The risk of gallbladder dysplasia or cancer was 1.1% in all polyps (0% in polyps < 10 mm; 10% in polyps ≥ 10 mm). The polyp size (P = 0.0001) was predictor of cancer; however, patient's age (P = 0.1085), number of polyps (P = 0.9983), symptomatic polyps (P = 0.3267), and change in size (P = 0.9012) were not. Size of 21 mm was cut-off for risk of cancer (area under the curve [AUC]: 0.995, P < 0.001) and 11.8 mm for risk of dysplasia or cancer (AUC: 0.986, P < 0.001). The mean polyp growth rate was 0.3 mm/year and polyp disappearance rate was 16%. CONCLUSIONS: The GP size remains the only predictor of malignant changes regardless of patient's age, patient's symptoms and number of polyps. The polyp growth rate is unremarkable, and a significant proportion disappears during follow-up. We changed our follow-up protocol with reduced number of scans and early discharge policy.

Unique case of abdominal aortic aneurysm causing obstructive jaundice and duodenal obstruction.

Obstruction of the duodenum by an abdominal aortic aneurysm (AAA) (aortoduodenal syndrome) has rarely been reported. It presents with symptoms of upper gastrointestinal (GI) tract obstruction. Obstructive jaundice caused by an AAA is also extremely rare and requires high clinical suspicion. We present a unique case with informed consent of an elderly gentleman who presented with both rare presentations over a course of few months. After extensive literature search, we have found case reports of patients showing either of the two unusual presentations, but none were found to show them together.

Can we detect fibrofatty band in patients with bowel obstruction on CT scan?

Fibrofatty bands are composed of adipose tissue and connective tissue and can tangle around the bowel and caused intestinal obstruction. Currently, there is a lack of radiological teaching or guidance on how to identify fibrofatty band in patients with bowel obstruction. The true incidence of fibrofatty band-induced bowel obstruction is likely to have been overlooked. We present a case series of patients with fibrofatty bands with different features and aim to highlight the key radiological findings that may help in the radiological diagnosis. We advocate that these features should be incorporated into the current algorithm for radiologist when assessing scan images of patients with intestinal obstruction.

Secondary peritoneal hydatidosis, the challenges of echinococcal disease in South Sudan: a case report.

A 28 year old male presented to the Juba Teaching Hospital with progressive shortness of breath. 18 months prior to admission, he presented to a rural hospital with severe abdominal pain. An emergency laparotomy was performed, and a large hepatic cyst was removed. Examination at the Juba Teaching hospital revealed a grossly distended abdomen with multiple palpable masses per abdomen. An Abdominal Ultrasound revealed multiple loculated cysts throughout the abdomen. A diagnosis of Secondary Peritoneal Hydatidosis resulting from incorrectly performed surgery was made. The patient was conservatively treated and at 14 weeks, the cysts showed a moderate reduction in size. Cystic Echinococcus (CE) is common in South Sudan and has a considerable disease burden throughout the developing world. Greater governmental and international support is required to develop effective control measures for these diseases.