A Spontaneous Heterotopic Pregnancy Presenting as Acute Appendicitis.

Heterotopic pregnancy (HP) occurs when there is a simultaneous intrauterine and extrauterine pregnancy, either viable or non-viable. Although spontaneous HP is rare, it is important to consider this possibility. Acute appendicitis (AA) is a common non-obstetric surgical emergency in pregnant women. Diagnosing HP can be challenging, particularly in pregnant women who present with symptoms such as right iliac fossa pain and an acute abdomen. As HP may not be initially suspected in the presence of a viable intrauterine pregnancy, we present an intriguing case of spontaneous HP initially presenting as AA, along with a literature review. Our objective is to raise awareness of HP among trainee obstetricians and general surgeons.

Instrumental detection of cystic duct stones during laparoscopic cholecystectomy.

Residual cystic duct stones (CDSs) after cholecystectomy have been recognized as a cause of post-cholecystectomy pain. This study was undertaken to determine the incidence of CDSs during laparoscopic cholecystectomy (LC). A cohort of 330 consecutive patients (80 males and 250 females) undergoing LC between November 2006 and May 2010 was studied. Their age ranged between 16 and 88 years (median 50, IQR: 36.62). The data were prospectively collected of preoperative liver function tests, imaging, the presence of intraoperative CDSs, and common bile duct stones at on-table cholangiogram. CDSs were detected intraoperatively in 64 of the 330 patients (19%). Ultrasound failed to detect CDSs in any of these cases. Deranged liver function tests were noted in 73% of the patients with CDSs and in 57% without CDSs. Common bile duct stones were detected in 9% (29) of the 330 patients. CDSs occur commonly at routine cholecystectomy, and preoperative investigations are not helpful in their diagnosis. As CDSs may lead to postoperative morbidity, they should be actively sought out during surgery if present.

Neuroma of a double gallbladder: a case report.

We report a case of 55 year old male patient who presented with recurrent upper abdominal pain following a laparoscopic cholecystectomy. A subsequent diagnostic laparoscopy revealed the presence of a second gallbladder which was initially missed. The peculiarity of his symptoms can in part be explained by the presence of a traumatic neuroma in his second gallbladder. A subsequent cholecystectomy led to a complete resolution of this patient's signs and symptoms. As far as we know this is the first report in the literature of a traumatic neuroma in a second gallbladder.

Do we need histology for a normal-looking gallbladder?

BACKGROUND/PURPOSE: Gallbladder cancer (GBC) is a rare malignancy with poor overall prognosis. Simple cholecystectomy is curative if the cancer is limited to mucosa. We aimed here to investigate the need for routine histological examination of gallbladder. METHODS: We carried out a retrospective review of 2890 final pathology reports of processed gallbladder specimens following cholecystectomy due to gallstones disease. The review covered the 10-year period from 1994 to 2004. The notes of all cases of gallbladder cancer were scrutinized, with particular emphasis on presentation, preoperative diagnostic tools using abdominal ultrasound and computed tomography scan, operative findings, and the histology results. RESULTS: Gallbladder cancer (GBC) was detected in five specimens (0.17%), dysplasia in six (0.2%), and secondaries to gallbladder in three (0.1%). Histological findings confirmed gallstone disease in 97% and rare benign pathology in 3%. The median age of patients with GBC was 61 years (range, 59-84 years). In all five patients, cancer was isolated from thickened fibrotic wall on macroscopic appearance and spread through all layers of the gallbladder wall. The percentage of thickened-wall gallbladder in this study was 38.02% and the cancer incidence in the thickened wall was 0.45%. CONCLUSIONS: A selective policy rather than routine histological examination of nonfibrotic or thickened-wall gallbladder has to be considered. This will reduce the burden on pathology departments, with significant cost savings.