Gallstone among Patients Presenting to the Department of Surgery in a Tertiary Care Center: A Descriptive Cross-sectional Study.

Introduction: Gallstone is the most common biliary pathology. Once thought of as a disease of the western world, the incidence and burden of cholelithiasis are increasing in Asia. Its literature from Nepal is however still primitive. The study aimed to find out the prevalence of gallstone among patients presenting to the Department of Surgery in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients presenting to the Department of Surgery after receiving ethical approval from the Institutional Review Committee (Registration number: 625). The study was conducted from 1 June 2022 to 1 November 2022. Patients with age more than 18 years were included and patients less than 18 years of age, having common bile duct stones, suffering from biliary malignancy or having an immunocompromised state were excluded. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 1700 patients, gallstone was seen in 200 (11.76%) (10.23-13.29, 95% Confidence Interval). Among the 200 patients, 133 of them (66.50%) were females. Multiple gallstones were present in 118 (59%) cases whereas 82 (41%) cases had a single stone. Conclusions: The prevalence of gallstone was found to be similar as compared to other reported literature. Keywords: cholelithiasis; gallbladder; prevalence.

A life-threatening complication of biliary peritonitis following T-tube removal: A case report and review of literature.

Introduction and importance: The purpose of T-tubes is to induce inflammation around it in the common bile duct, forming a fibrous tract for drainage of bile. The leakage of bile into the peritoneum is a drastic complication following T-tube removal. A provisional diagnosis of choleperitoneum is established in the presence of persistent pain with guarding and rigidity. Imaging techniques can be used for the identification of biliary leakage. With most cases, patients recover with either conservative or surgical management. Case presentation: We present you a 65 years old malnourished female with features of choleperitoneum immediately following T-tube removal and was planned for conservative management with constant monitoring in surgical intensive care unit. The patient deteriorated despite adequate treatment and went into septic shock which resulted into her demise. Clinical discussion: Biliary peritonitis is not very uncommon but a life-threatening complication of T-tube removal. Poor nutritional status may also lead to delay in fistulous tract formation and there is a relative risk of biliary leakage during removal of T-tube. The use of a latex T-tube is more effective in mature tract formation and has less incidence of bile leakage. Seldinger's method, which involves using a wire to guide the removal of the T-tube, shows a significant reduction of biliary leakage. Conclusion: The mortality in biliary peritonitis significantly rises in cases of infected bile. The adverse reaction following the removal of T-tube was 4.3% and about 3% were severe enough to be admitted to the hospital.