When to remove the drainage catheter in patients with percutaneous cholecystostomy?

The treatment for patients with acute calculous cholecystitis who have high surgical risk with percutaneous cholecystostomy instead of surgery is an appropriate alternative choice. The aim of this study was to examine the promising percutaneous cholecystostomy intervention to share our experiences about the duration of catheter that has yet to be determined. A total of 163 patients diagnosed with acute calculous cholecystitis and treated with percutaneous cholecystostomy between January 2011 and July 2020 were reviewed retrospectively. The Tokyo Guidelines 2018 were used to diagnose and grade patients with acute cholecystitis. The mean age was 71.81±12.81 years. According to the Tokyo grading, 143 patients had grade 2 and 20 patients had grade 3 disease. The mean duration of catheter was 39.12±37 (1-270) days. Minimal bile leakage into the peritoneum was noted in 3 (1.8%) patients during the procedure. The rate of complications during follow-up of the patients who underwent percutaneous cholecystostomy was 6.9% (n=11), and the most common complication was catheter dislocation. Cholecystectomy was performed in 33.1% (n=54) of the patients at follow-up. Post-cholecystectomy complication rate was 12.9%. At the follow-up, the rate of recurrent acute cholecystitis episodes was 5.5%, while the mortality rate was 1.8%. The length of follow-up was five years. The rate of recurrence was significantly higher among the patients with catheter for <21 days. We recommend that the duration of catheter should be minimum 21 days in patients undergoing percutaneous cholecystostomy.

O tratamento para pacientes com colecistite calculosa aguda que apresentam alto risco cirúrgico com colecistostomia percutânea em vez de cirurgia é uma alternativa apropriada. O objetivo deste estudo foi examinar a promissora intervenção de colecistostomia percutânea para compartilhar nossas experiências sobre a duração do cateter que ainda não foi determinada. Um total de 163 pacientes diagnosticados com colecistite calculosa aguda e tratados com colecistostomia percutânea entre janeiro de 2011 e julho de 2020 foram revisados ​​retrospectivamente. As Diretrizes de Tóquio 2018 foram usadas para diagnosticar e classificar pacientes com colecistite aguda. A média de idade foi de 71,81±12,81 anos. De acordo com a classificação de Tóquio, 143 pacientes tinham grau 2 e 20 pacientes tinham doença de grau 3. A duração média do cateter foi de 39,12±37 (1-270) dias. Vazamento mínimo de bile no peritônio foi observado em 3 (1,8%) pacientes durante o procedimento. A taxa de complicações durante o seguimento dos pacientes submetidos à colecistostomia percutânea foi de 6,9% (n=11), sendo a luxação do cateter a complicação mais comum. A colecistectomia foi realizada em 33,1% (n=54) dos pacientes no seguimento. A taxa de complicação pós-colecistectomia foi de 12,9%. No seguimento, a taxa de episódios recorrentes de colecistite aguda foi de 5,5%, enquanto a taxa de mortalidade foi de 1,8%. O tempo de seguimento foi de cinco anos. A taxa de recorrência foi significativamente maior entre os pacientes com cateter <21 dias. Recomendamos que a duração do cateter seja de no mínimo 21 dias em pacientes submetidos à colecistostomia percutânea.

Acute cholecystitis in a situs inversus totalis. Case report.

INTRODUCTION: Situs inversus totalis (SIT) is an autosomal recessive congenital disorder. Acute cholecystitis is a diagnosis challenge in patients with SIT. CLINICAL CASE: A 26-year-old female who presented with atypical gallbladder colic. Assessed by Surgery, concluding diagnosis of acute cholecystitis and SIT. Laparoscopic cholecystectomy was performed. DISCUSSION: SIT is a rare congenital pathology, defined by the transposition of thoracic and abdominal viscera. Most patients are asymptomatic and they're discovered incidentally. The SIT goes far beyond the paradigm of treatments and surgical techniques. CONCLUSIONS: The pathology turns into a behavior modification for surgical treatment, however, it is possible to carry them out successful procedure.

INTRODUCCIÓN: El situs inversus total (SIT) es un trastorno congénito autosómico recesivo. La colecistitis aguda es un reto diagnóstico en los pacientes con SIT. CASO CLÍNICO: Mujer de 26 años con cólico vesicular atípico. Valorada por cirugía, se concluye el diagnóstico de colecistitis aguda y SIT. Se realiza colecistectomía laparoscópica, sin complicaciones. DISCUSIÓN: En el SIT definido por transposición de vísceras torácicas y abdominales, la mayoría de los pacientes son asintomáticos y se descubre incidentalmente. El SIT supera el paradigma de tratamientos y técnicas quirúrgicas. CONCLUSIONES: Esta patología requiere modificación de conductas para el tratamiento quirúrgico, pero es posible realizarlo con éxito.

Hemobilia and acute hemocolecyst as an unusual presentation of gallbladder cancer.

Gallbladder cancer that presents as acute cholecystitis associated with hemocholecyst and hemobilia is a rare entity. There are few cases reported in the literature. We present a case of gallbladder carcinoma diagnosed after emergency cholecystectomy, performed due to hemobilia and acute cholecystitis due to hemocholecyst.

El cáncer de vesícula biliar que se presenta como una colecistitis aguda asociada a hemocolecisto y hemobilia es muy infrecuente. Hasta la fecha hay pocos casos informados en la literatura. Presentamos un caso de carcinoma de vesícula biliar diagnosticado tras colecistectomía de urgencia, realizada por hemobilia y colecistitis aguda por hemocolecisto.

Hemoperitoneum secondary to haemocholecyst due to acute cholecystitis.

The haemocholecyst is a rare disease with a low index of suspiction, which is even lower if the patient does not present risk factors. Likewise, the course of this pathology with a haemoperitoneum without vesicular perforation is equally infrequent. We present an unusual case in which the diagnosis of the patient was carried out intraoperatively. We consider that communicating these unusual cases in clinical practice helps to increase clinical suspiction and prompt diagnosis.

El hemocolecisto es una patología poco frecuente y con un índice bajo de sospecha, que todavía es menor si el paciente no presenta factores de riesgo. Asimismo, su curso con clínica de hemoperitoneo sin perforación vesicular es igualmente infrecuente. Presentamos un caso poco habitual en el cual el diagnóstico de la paciente se llevó a cabo intraoperatoriamente. Consideramos que comunicar estos casos poco habituales en la práctica clínica colabora a aumentar la sospecha clínica y el diagnóstico precoz.

Acute hemorrhagic cholecystitis with gallbladder rupture and massive intra-abdominal hemorrhage

Acute hemorrhagic cholecystitis is a rare, life-threatening condition that can be further complicated by perforation of the gallbladder. We describe a patient with clinical and radiologic findings of acute cholecystitis with a gallbladder rupture and massive intra-abdominal bleeding. Our patient is a 67-year-old male who presented with an ischemic stroke and was treated with early tissue plasminogen activator. His hospital course was complicated by a fall requiring posterior spinal fusion surgery. He recovered well, but several days later developed subxiphoid and right upper quadrant pain and an episode of hemobilia and melena. A computed tomography scan revealed an inflamed, distended gallbladder with indistinct margins and a large hematoma in the gallbladder fossa extending to the right paracolic gutter. The patient also developed hemodynamic instability concerning for hemorrhagic shock. He underwent an emergent laparoscopic converted to open subtotal fenestrating cholecystectomy with abdominal washout for management of his acute hemorrhagic cholecystitis with massive intra-abdominal hemorrhage. Prompt recognition of this lethal condition in high-risk patients is crucial for optimizing patient care.

[Astrocytoma and epilepsy. Clinical case]. / Astrocitoma y epilepsia. Caso clínico.

BACKGROUND: Pilocytic astrocytoma is a rare tumour, usually occurring in paediatric ages, and mainly located in the posterior fossa. It can cause hydrocephalus and intracranial hypertension and, less frequently, seizures, or a focal neurological deficit. The main imaging study by magnetic resonance imaging, which shows a tumour with solid and cystic components without peri-lesional swelling. The election treatment is surgical, and the patient is considered cured if a total resection is accomplished. CLINICAL CASE: The case is presented of 22-year-old female patient with a supratentorial pilocytic astrocytoma and epilepsy. Histopathology reported a low grade glial proliferation, with an extensive fibrillar matrix, small cells without atypia, extensive calcifications and piloid areas consisting of bipolar fusiform cells, and some Rosenthal fibres. There were also spongiotic areas consisting of multipolar cells and associated microcysts. The final report was a pilocytic astrocytoma. CONCLUSIONS: Pilocytic astrocytoma is more frequent in paediatric patients and in the posterior fossa. The case presented is of a young female adult with supratentorial location, making it a special case. The surgery achieved a total resection. The long-term prognosis is good, but it is necessary to perform a follow-up, particularly in adult patients because of a higher risk of recurrence.

The role of body mass index class in cholecystectomy after acute cholecystitis: An American College of Surgeons National Surgical Quality Improvement Program analysis.

BACKGROUND: Obesity is a risk factor for cholelithiasis leading to acute cholecystitis which is treated with cholecystectomy. The purpose of this study was to analyze the associations between body mass index class and the intended operative approach (laparoscopic versus open) for and outcomes of cholecystectomy for acute cholecystitis. METHODS: We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program data from 2008-2013. The effects of body mass index class on intended procedure type (laparoscopic versus open), conversion from laparoscopic to open operation, and outcomes after cholecystectomy were examined using multivariable logistic regression. RESULTS: Data on 20,979 patients who underwent cholecystectomy for acute cholecystitis showed that 18,228 (87%) had a laparoscopic operation; 639 (4%) of these patients required conversion to an open approach; and 2,751 (13%) underwent intended open cholecystectomy. There was an independent association between super obesity (body mass index 50+) and an intended open operation (odds ratio 1.53, 95% confidence interval 1.14-2.05, P = .01). An intended open procedure (odds ratio 3.10, 95% confidence interval 2.40-4.02, P < .0001) and conversion (odds ratio 3.45, 95% confidence interval 2.16-5.50, P < .0001) were associated with increased risk of death/serious morbidity in a model, even when controlling for all other important factors. In the same model, body mass index class was not associated with increased death/serious morbidity. Outcomes after conversion were not substantially worse than outcomes after intended open cholecystectomy. CONCLUSION: This study supports the possibility that an intended open approach to acute cholecystitis, not body mass index class, is associated with worse outcomes after cholecystectomy. An initial attempt at laparoscopy may benefit patients, even those at the highest end of the body mass index spectrum.

Fístula colecistocutánea espontánea / Spontaneous cholecystocutaneous fistula

Background: Spontaneous cholecystocutaneous fistula is a rare complication of acute cholecystitis. The incidence has decreased due to prompt and early surgical management of patients with acute cholecystitis. Case report: We report a 64 years old woman consulting for erythematous soft and non-tender mass in right flank. Ultrasound revealed the cholecystocutaneous fistula. The fistulous tract and the gallbladder were excised from average laparotomy.

Introducción: La fístula colecistocutánea es una rara complicación de la colecistitis aguda. La incidencia de esta patología ha disminuido debido al abordaje quirúrgico precoz de los pacientes con colecistitis aguda. Caso clínico: Reportamos el caso de una mujer de 64 años de edad que consulta por un nódulo con signos inflamatorios en el flanco derecho. La fístula fue diagnosticada mediante ecografía. La fístula y la vesícula fueron extirpadas mediante una laparotomía media.

Outcomes of laparoscopic cholecystectomy in octogenarians.

BACKGROUND AND OBJECTIVES: Extremely elderly patients usually present with complicated gallstone disease and are less likely to undergo definitive treatment. The purpose of this study was to evaluate the results of laparoscopic cholecystectomy in octogenarians, with an interest in patients presenting initially with complicated gallstone disease and pancreatitis who underwent laparoscopic cholecystectomy during the same hospitalization. METHODS: Data for 42 patients > or = 80 years who underwent an elective laparoscopic cholecystectomy between January 2007 and August 2011 were retrospectively reviewed. Indications for the procedure were stratified into 2 groups: Outpatients, who were admitted electively to undergo cholecystectomy, and Inpatients, who came to our Emergency Room due to complicated biliary diseases. Data analysis included age, sex, ASA score, conversion to open surgery, time spent under general anesthesia, and length of hospital stay. RESULTS: Mean age was 83.9 years; 19 (45.2%) were men. Thirteen patients (30.9%) were in the outpatient group, and 13 (30.9%) had a preoperative ASA of 3. Fourteen patients (33.3%) needed ICU. Two patients (4.8%) had their surgery converted. There were 7 (16.7%) postoperative complications, all of them classified as Dindo-Clavien I or II. No differences were noted between groups regarding conversion rates or complications. We had no mortalities in this series. There was no difference in hospital length of stay between the groups. CONCLUSION: Laparoscopic cholecystectomy in the extremely elderly is safe, with acceptable morbidity. Patients with complicated gallstone disease seem not to have worse postoperative outcomes once the initial diagnosis is properly treated and would benefit from definitive therapy during the same hospitalization.

Cirugía temprana en colecistitis aguda, Servicio de Emergencia del Hospital Nacional Daniel A. Carrión - Callao - periodo Enero 2004 a Diciembre 2006 / Early surgery in acute cholecystitis, Emergency Service at the National Hospital Daniel A. Carrion - Callao - period January 2004 to December 2006

El presente estudio se realizó en el Hospital Nacional "Daniel A. Carrión" Callao. Perú entre Enero 2004 - Diciembre 2006 en el Servicio de Emergencia Cirugía. Se realizaron 254 colecistectomías convencionales en pacientes con el diagnóstico de colecistitis aguda, que posteriormente pasaron a ser hospitalizados en el servicio de cirugía 4B. El 68.9 por ciento de las intervenciones correspondió a pacientes de sexo femenino y el 31.1 por ciento correspondió al sexo masculino. El mayor porcentaje de pacientes llegaron a la emergencia con un tiempo de enfermedad mayor de tres días 40.2 por ciento. El tiempo operatorio en 200 casos (78.4 por ciento) fue menor de dos horas. 48 casos (18.8 por ciento) de 2 a 3 horas. 6 casos (2.3 por ciento) más de 3 horas. Siendo el tiempo quirúrgico promedio de 102 minutos. El 66.9 por ciento de pacientes ha tenido como diagnóstico pre operatorio colecistitis aguda litiásica no complicada, mientras que el 33.1 por ciento fue diagnosticado de colecistitis aguda complicada. En el 31.5 por ciento de pacientes intervenidos se halló como diagnóstico post operatorio colecistitis aguda no complicada. Mientras que en el 68.5 por c se halló colecistitis aguda complicada. Dentro de las complicaciones asociadas a la colecistitis aguda el 11 por ciento presentó colecistitis aguda plastronada. El 8.2 por ciento colecistitis aguda más coledocolitiasis más colangitis. El 2.7 por ciento colecistitis aguda más colangitis. El 2.3 por ciento colecistitis más coledocolitiasis. El 1.5 por ciento colecistitis aguda más peritonitis biliar y el 1.2 por ciento colecistitis aguda más absceso perivesicular. Otras complicaciones asociadas a los hallazgos intra operatorios como complicaciones más serias al cuadro agudo de colecistitis, tenemos que el 3.9 por ciento de pacientes presentó pancreatitis aguda, de los cuales el 2.7 por ciento fue pancreatitis aguda leve y el 1.1 por ciento pancreatitis aguda grave. También se halló 2 por ciento de casos de síndrome de Mirizzi (Mirizzi I: 0.8 por ciento, Mirizzi II: 0.3 por ciento, Mirizzi IV: 0.8 por ciento). El 0.8 por ciento presentó fístula colecisto entérica (1 caso con perforación de vesícula a duodeno y otro de vesícula a yeyuno). El 8.2 por ciento de pacientes presentó complicaciones post operatorias que se distribuyeron así: 3.5 por ciento infección de herida operatoria. 2.0 por ciento otros no relacionados a la cirugía. 0.7 por ciento hematoma de herida operatoria. 0.7 por ciento fístula bilio cutánea. 0.7 por ciento seroma de herida operatoria. 0.3 por ciento hemoperitoneo. El 46.8 por ciento de pacientes ha tenido leucocitosis de 10,000 a 15,000/mm. El 30.7 por ciento leucocitosis mayor de 15,000/mm. El 20.8 por ciento leucocitos de 5,000 a 10,000/mm. El 1.5 por ciento leucocitos menor de 5,000/mm. Teniéndose que el 77.6 por ciento ha tenido leucocitosis mayor de 10,000/mm. El 85 por ciento de pacientes tenía valores normales de amilasa. El 7.4 por ciento valores elevados de amilasa. El 3.9 por ciento tenía valores diagnósticos de pancreatitis y el 3.5 por ciento no se realizó el dosaje de amilasa. El 43.9 por ciento de pacientes tenía diagnóstico ecográfico de colecistitis aguda litiásica. El 28.7 por ciento colecistitis crónica calculosa. El 23.2 por ciento colecistitis crónica calculosa reagudizada. El 3 por ciento litiasis vesicular y el 2 por ciento colecistitis aguda alitiásica

Acute cholecystitis at initial presentation of polyarteritis nodosa.

Polyarteritis nodosa (PAN) is a systemic vasculitis of unknown etiology. Although gastrointestinal involvement may be seen in half of the cases of PAN, vasculitis of the gallbladder at the disease onset is a rare presentation. We report a case of a 48-year-old man who was admitted due to acute cholecystitis. He had complained of myalgia, fever and weight loss for about one month prior to admission. At physical examination, mild hypertension and calf pain were noted. He underwent a cholecystectomy; histopathological evaluation disclosed necrotizing vasculitis suggestive of PAN. We emphasize that cholecystitis may be part of the initial presentation of systemic vasculitis.

Conversión en colecistectomía laparoscópica. Experiencia hospital San Martín de Quillota, 8 años después / Conversion in laparascopic cholecystectomy. Experience of hospital San Martín de Quillota, 8 years later

La colecistectomía laparoscópica se realiza en nuestro país 1990 y en el Hospital San Martín de Quillota desde 1992. Se realizó un estudio sobre las causas de conversión de colecistectomía laparoscópica a colecistectomía clásica, transcurrido un tiempo de aprendizaje por el staff de cirujanos, comparando las causas de conversión con un estudio previo realizado en el Hospital San Martín de Quillota entre 1992-1995. Se evaluaron las cirugías efectuadas entre julio del 2000 hasta marzo 2002, sumando 799 casos, de los cuales 45 debieron ser convertidos. Se evaluaron las variables edad, sexo, antecedentes mórbidos, clínica, ecografía, diagnóstico pre y post operatorio, tiempo operatorio, anatomía patológica, complicaciones posteriores y las causas de la conversión. En nuestro estudio del total de cirugías, un 5,6 por ciento de los casos debieron ser convertidos, en comparación con el índice de conversión de un 7,8 por ciento obtenido en el mismo centro hace 8 años. De las cuasas de conversión se observó una variación con respecto al estudio preliminar. En este último, la principal causa de conversión fue la dificultad técnica (29,2 por ciento), en cambio en el estudio actual fue el plastrón vesicular (37 por ciento de los casos). Nuestros resultados, al igual como los de otros autores, reflejan la transición entre la dificultad técnica y el hallazgo de plastrón como la primera causa de conversión, una vez transcurrido la curva de aprendizaje de esta técnica.