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2.
Acta Gastroenterol Belg ; 81(3): 393-397, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30350527

RESUMO

BACKGROUND AND STUDY AIMS: Conventional use of percutaneous cholecystostomy [PC] is bridging therapy to delayed cholecystectomy for acute cholecystitis in high-surgical risk patients. Primary aim of this report is to evaluate the long-term outcome of PC as a definitive treatment for acute acalculous cholecystitis [AAC]. PATIENTS AND METHODS: Seventy-one AAC patients who underwent PC procedure were identified. Fifty-one interventions in 47 patients who were treated only with PC and followed-up after catheter withdrawal were reviewed to evaluate the long-term efficacy of PC as a definitive treatment for AAC. RESULTS: Technical and short-term clinical success rates were 100% and 92%, respectively. In-hospital mortality rate was 9.3%, minor complication rate was 5.3%, major complication rate was 2.7% and procedure related mortality was 0%. Median follow-up after catheter withdrawal was 8 months. Long-term primary clinical success after removal of the catheter was 87.2%. With the repeated PC in 4 of 6 recurrences, clinical success was 95.7%. Presence of bile sludge, perforation or a co-existing disease did not result in a significant difference in recurrence free survival. CONCLUSIONS: PC was a safe and easy to perform procedure with high positive clinical response and low long-term recurrence rate. PC without subsequent cholecystectomy may be a favorable treatment for AAC with respect to high surgical risk present in most of the AAC patients.


Assuntos
Colecistite Acalculosa/cirurgia , Colecistite Aguda/cirurgia , Colecistostomia/métodos , Vesícula Biliar/cirurgia , Colecistite Acalculosa/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bile , Colecistite Aguda/epidemiologia , Comorbidade , Drenagem/métodos , Feminino , Seguimentos , Vesícula Biliar/patologia , Mortalidade Hospitalar , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Perfuração Espontânea/epidemiologia
3.
BMJ Case Rep ; 20182018 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-29654105

RESUMO

We present the case of a young female with symptoms of biliary colic and a biochemical profile consistent with biliary obstruction. Imaging was suspicious for Mirizzi's syndrome. Intraoperatively, the patient was found to have a complete intrahepatic gallbladder causing common hepatic duct compression with final pathology confirming acute cholecystitis. We review the embryological development of the gallbladder as well as clinical presentation of Mirizzi's syndrome. Special consideration for clinical workup and surgical management is discussed.


Assuntos
Colecistite Acalculosa/complicações , Coristoma/complicações , Vesícula Biliar , Hepatopatias/etiologia , Síndrome de Mirizzi/etiologia , Colecistite Acalculosa/diagnóstico , Colecistite Acalculosa/cirurgia , Doença Aguda , Adulto , Colangiopancreatografia Retrógrada Endoscópica , Coristoma/diagnóstico por imagem , Feminino , Humanos , Hepatopatias/diagnóstico por imagem , Imagem por Ressonância Magnética , Síndrome de Mirizzi/diagnóstico , Síndrome de Mirizzi/cirurgia , Stents
4.
Obes Surg ; 28(7): 2092-2095, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29667024

RESUMO

BACKGROUND: Staple line leak is one of the most challenging complications following laparoscopic sleeve gastrectomy, with a rate reaching near 1%. Its management often implicates a multidisciplinary approach and experienced bariatric and metabolic surgeons. The literature is abundant on various approaches to treat single staple line leak with variable results. But what to do in front of an intra-op incidental finding of double gastric fistulae? METHODS: In this article, we describe a new successful surgical treatment option of double Baltazar technique for a patient who was found to have two gastric fistulae post-sleeve gastrectomy. We aim to demonstrate that this approach is safe and effective and can help avoid major side effects of traditional treatment options for such complications. RESULTS: The patient presented 20 days following a laparoscopic sleeve gastrectomy in a severe septic condition and was found to have a gastric leak. During surgical repair, unlike the usual single proximal fistula findings, another opening was identified more distally. Decision was made to proceed with a double fistulo-jejunostomy. It was a feasible technique, with no intra-op complications. Post-operatively, the patient had a successful recover, with no residual leak. CONCLUSIONS: Double Baltazar technique is a successful and feasible treatment option for patients presenting with two gastric fistulae following sleeve gastrectomy. This is the first case report describing this new technique, and its success should encourage more similar trials and avoid more aggressive surgical options such as total gastrectomy or gastric bypass.


Assuntos
Colecistite Acalculosa/cirurgia , Fístula Anastomótica/cirurgia , Gastrectomia/efeitos adversos , Fístula Gástrica/cirurgia , Jejunostomia/métodos , Obesidade Mórbida/cirurgia , Reoperação/métodos , Colecistite Acalculosa/diagnóstico , Colecistite Acalculosa/etiologia , Doença Aguda , Fístula Anastomótica/etiologia , Colecistectomia Laparoscópica/métodos , Gastrectomia/métodos , Derivação Gástrica/métodos , Fístula Gástrica/diagnóstico , Fístula Gástrica/etiologia , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Estômago/cirurgia , Grampeamento Cirúrgico/efeitos adversos , Grampeamento Cirúrgico/métodos , Ultrassonografia de Intervenção , Cicatrização
5.
Am J Surg ; 215(1): 116-119, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28669533

RESUMO

This is the largest single center retrospective study to date looking at response to laparoscopic cholecystectomy in patients with acalculous biliary disease. A chart review was completed on 1116 patients from 2009 to 2014 who had admitting diagnoses related to acalculous cholecystitis and biliary colic. Four hundred and seventy four patients were available for long term follow up (6 months or longer). Multiple factors were studied as related to cholescintigraphy scans with cholecystokinin administration (HIDA with CCK). Hyperkinetic, normokinetic and hypokinetic ejection fractions (EF), as well as reproduction of symptoms with administration of CCK were catagorized. ROME III criteria (Table 1) were used to describe cholecystitis/biliary colic symptoms. (1). It was found that rates of resolution of symptoms after laparoscopic cholecystectomy in normokinetic and hypokinetic were similar. It was also found that reproduction of symptoms after administration of CCK was a better predictor of favorable response to surgery than calculated ejection fraction.


Assuntos
Colecistite Acalculosa/cirurgia , Discinesia Biliar/cirurgia , Colecistectomia Laparoscópica , Colecistite Acalculosa/diagnóstico , Colecistite Acalculosa/etiologia , Colecistite Acalculosa/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Discinesia Biliar/complicações , Discinesia Biliar/diagnóstico , Discinesia Biliar/metabolismo , Feminino , Seguimentos , Humanos , Cinética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
6.
Dig Surg ; 35(2): 171-176, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28704814

RESUMO

BACKGROUND: Acute acalculous cholecystitis (AAC) accounts for 5-10% of cases of acute cholecystitis. The advantage of interval cholecystectomy for patients with AAC is unclear. Therefore, a retrospective analysis of patients diagnosed with AAC at our institution was performed over a 5-year period. METHODS: Patients were identified via hospital coding using the keywords "acalculous cholecystitis, cholecystostomy and gall bladder perforation." Follow-up data was obtained by performing a retrospective review of the patients' hospital records. RESULTS: A total of 33 patients with AAC were identified and followed for a median period of 18 months. The median age at presentation was 70 (10-96) and American Society of Anesthesiologists (ASA) grade was 3 (1-5). Twenty-three patients (70%) were treated with antibiotics alone, 7 patients (21%) with percutaneous cholecystostomy and 3 patients (9%) with laparoscopic cholecystectomy. The 90-day mortality rate was 30% with significant correlation to comorbid status, as all deaths occurred in ASA grade 3-5 individuals (p = 0.020). Two patients (6%) developed recurrent AAC and were managed non-operatively. CONCLUSION: Antibiotics and cholecystostomy were the mainstay of AAC management, and comorbid status influenced related mortality. Our results suggest that it appears safe to avoid interval cholecystectomy in patients who recover from AAC, as they are typically high-risk surgical candidates.


Assuntos
Colecistite Acalculosa/cirurgia , Antibacterianos/uso terapêutico , Colecistectomia/métodos , Procedimentos Cirúrgicos Eletivos/mortalidade , Procedimentos Cirúrgicos Eletivos/métodos , Colecistite Acalculosa/diagnóstico por imagem , Colecistite Acalculosa/tratamento farmacológico , Colecistite Acalculosa/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiografia/métodos , Colecistectomia/mortalidade , Colecistite Aguda/diagnóstico por imagem , Colecistite Aguda/tratamento farmacológico , Colecistite Aguda/mortalidade , Colecistite Aguda/cirurgia , Colecistostomia/métodos , Colecistostomia/estatística & dados numéricos , Estudos de Coortes , Bases de Dados Factuais , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Fatores de Tempo , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia Doppler , Reino Unido
8.
Eur Radiol ; 28(4): 1449-1455, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29116391

RESUMO

OBJECTIVES: To examine the outcomes of percutaneous cholecystostomy (PC) in patients with acute acalculous cholecystitis (AAC). METHODS: The study population comprised 271 patients (mean age, 72 years; range, 22-97 years, male, n=169) with AAC treated with PC with or without subsequent cholecystectomy. Clinical data from total 271 patients were analysed, and outcomes were assessed according to whether the catheter was removed or remained indwelling. Patient survival and recurrence rates were calculated. RESULTS: Symptom resolution and significant improvement of laboratory test values were achieved in 235 patients (86.7%) within 4 days after PC. Complications occurred in six patients (2.2%). Interval elective cholecystectomy was performed in 127 (46.8%) patients. Among the remaining 121 patients, successful removal of the PC catheter was achieved in 88 patients (72.7%) at a mean of 30 days (range, 4-365 days). Of the catheter removal group, 86/88 (97.7%) were successfully treated with the initial PC, whereas two (2.3%) experienced recurrence of cholecystitis. Cumulative recurrence rates were 1.1%, 2.7%, and 2.7% at 1, 2, and 8 years, respectively. CONCLUSIONS: The good therapeutic outcomes of PC and low recurrence rate suggest that PC can be a definitive treatment option in the majority of AAC patients. KEY POINTS: • Many patients with AAC are too ill to undergo cholecystectomy. • PC in AAC patients shows low complication and recurrence rate. • PC solely can be a definitive treatment option in the majority of AAC patients.


Assuntos
Colecistite Acalculosa/cirurgia , Colecistite Aguda/cirurgia , Colecistostomia/métodos , Colecistite Acalculosa/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia por Ressonância Magnética , Colecistite Aguda/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
9.
Pol Merkur Lekarski ; 43(255): 125-128, 2017 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-28987045

RESUMO

Acute acalculous cholecystitis (AAC) is a necroinflammatory disease of the gallbladder with no gallstones present. ACC is known to be a serious, even potentially lethal complication observed mainly in patients with various severe underlying conditions including trauma, burn and sepsis. Infection of cardiac implantable electronic devices may lead to cardiac device-related infective endocarditis (CDRIE). The authors describe a case of a 55-year-old female with a history of advanced heart failure and implantation/reimplantation of biventricular pacemaker/defibrillator (CRT-D) for cardiac resynchronization therapy. She was admitted presently due to the symptoms of septicemia. Echocardiography revealed CDRIE with mobile vegetations on pacemaker leads; chest computed tomography showed pulmonary infarctions. Staphylococcus aureus was cultured from the blood. Antibiotics were applied in accordance with antimicrobial susceptibility and were continued after percutaneous leads extraction and pacemaker explantation. After 6 weeks of hospitalization, nonspecific abdominal symptoms developed, ultrasonography and computed tomography confirmed AAC diagnosis. Laparoscopic cholecystectomy was performed. To the best of the authors' knowledge, the case presented is the first report of ACC in a patient with CDRIE due to infection of pacemaker leads.


Assuntos
Colecistite Acalculosa/etiologia , Terapia de Ressincronização Cardíaca/efeitos adversos , Endocardite Bacteriana/complicações , Infecções Estafilocócicas/complicações , Staphylococcus aureus/efeitos dos fármacos , Colecistite Acalculosa/diagnóstico por imagem , Colecistite Acalculosa/microbiologia , Colecistite Acalculosa/cirurgia , Antibacterianos/uso terapêutico , Colecistectomia Laparoscópica , Desfibriladores Implantáveis , Remoção de Dispositivo , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Marca-Passo Artificial , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico
10.
Rev. esp. enferm. dig ; 109(10): 708-718, oct. 2017. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-166825

RESUMO

Introducción y objetivos: actualmente no existe consenso entre colecistectomía o colecistostomía percutánea como elección terapéutica en la colecistitis aguda alitiásica. El objetivo de nuestro trabajo es revisar la evidencia científica acerca del tratamiento en estos pacientes según los hallazgos clínicos y radiológicos. Métodos: revisión sistemática de la literatura desde 2000 hasta 2016. La búsqueda se realizó usando PubMed, Índice Médico Español, Cochrane Library y Embase, siguiendo nuestros criterios de inclusión: idioma de publicación (inglés o español), pacientes adultos, etiología alitiásica y apropiado diseño de estudio. Resultados: se han identificado 1.013 artículos; finalmente, se han seleccionado para la revisión diez artículos que describían los resultados de pacientes tratados con colecistostomía percutánea y colecistectomía urgente, incluyendo cinco estudios observacionales controlados y cinco series de casos. No se han identificado estudios prospectivos o randomizados con los criterios de búsqueda. Los datos de la literatura y el examen de los resultados indicaron que, para la colecistitis aguda alitiásica, la colecistostomía percutánea puede ser un tratamiento definitivo sin requerir una colecistectomía electiva posterior. Conclusiones: la colecistostomía percutánea puede ser la primera opción de tratamiento en pacientes con colecistitis aguda alitiásica salvo en los casos que presenten perforación o gangrena vesicular. Los pacientes con bajo riesgo quirúrgico podrían beneficiarse de una colecistectomía, aunque ambas opciones de tratamiento pueden ser efectivas. La colecistostomía percutánea en pacientes con colecistitis aguda alitiásica puede ser un tratamiento definitivo sin necesidad de una colecistectomía electiva posterior. No obstante, la calidad de los estudios es, en general, baja y hace necesario tomar con cautela las recomendaciones finales (AU)


Background and objectives: there is currently no consensus with regard to the use of cholecystectomy or percutaneous cholecystostomy as the therapy of choice for acute acalculous cholecystitis. The goal of this study was to review the scientific evidence on the management of these patients according to clinical and radiographic findings. Methods: A systematic review of the literature from 2000 to 2016 was performed. The databases of PubMed, Índice Médico Español, Cochrane Library and Embase were searched according to the following inclusion criteria: publication language (English or Spanish), adult patients, acalculous etiology and appropriate study design. Results: A total of 1,013 articles were identified and ten articles were selected for review. These included five observational controlled studies and five case series which described the outcome of patients treated with percutaneous cholecystostomy and emergency cholecystectomy. No prospective or randomized studies were identified using the search criteria. The data from the literature and analysis of results suggested that percutaneous cholecystostomy may be a definitive therapy for acute acalculous cholecystitis with no need for subsequent elective cholecystectomy. Conclusions: Percutaneous cholecystostomy may be the first treatment option for patients with acute acalculous cholecystitis except in cases with a perforation or gallbladder gangrene. Patients at low surgical risk may benefit from cholecystectomy but both treatment options may be effective. Percutaneous cholecystostomy in patients with acute acalculous cholecystitis may be a definitive therapy with no need for a subsequent elective cholecystectomy. However, the overall quality of studies is low and the final recommendations should be considered with caution (AU)


Assuntos
Humanos , Colecistite Acalculosa/cirurgia , Colecistectomia/métodos , Sensibilidade e Especificidade , Medicina Baseada em Evidências/métodos , Laparoscopia/métodos , Colecistite Acalculosa , Bibliometria , Indicadores de Morbimortalidade , Diagnóstico Diferencial , Comorbidade
11.
Rev Esp Enferm Dig ; 109(10): 708-718, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28776380

RESUMO

BACKGROUND AND OBJECTIVES: There is currently no consensus with regard to the use of cholecystectomy or percutaneous cholecystostomy as the therapy of choice for acute acalculous cholecystitis. The goal of this study was to review the scientific evidence on the management of these patients according to clinical and radiographic findings. METHODS: A systematic review of the literature from 2000 to 2016 was performed. The databases of PubMed, Índice Médico Español, Cochrane Library and Embase were searched according to the following inclusion criteria: publication language (English or Spanish), adult patients, acalculous etiology and appropriate study design. RESULTS: A total of 1,013 articles were identified and ten articles were selected for review. These included five observational controlled studies and five case series which described the outcome of patients treated with percutaneous cholecystostomy and emergency cholecystectomy. No prospective or randomized studies were identified using the search criteria. The data from the literature and analysis of results suggested that percutaneous cholecystostomy may be a definitive therapy for acute acalculous cholecystitis with no need for subsequent elective cholecystectomy. CONCLUSIONS: Percutaneous cholecystostomy may be the first treatment option for patients with acute acalculous cholecystitis except in cases with a perforation or gallbladder gangrene. Patients at low surgical risk may benefit from cholecystectomy but both treatment options may be effective. Percutaneous cholecystostomy in patients with acute acalculous cholecystitis may be a definitive therapy with no need for a subsequent elective cholecystectomy. However, the overall quality of studies is low and the final recommendations should be considered with caution.


Assuntos
Colecistite Acalculosa/cirurgia , Colecistectomia/métodos , Humanos
12.
Medicine (Baltimore) ; 96(27): e7478, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28682919

RESUMO

There is no consensus of treatments for acute acalculous cholecystitis with systemic lupus erythematosus (SLE). The study was aimed to investigate the effect of the corticosteroid for these patients.A series of patients who were diagnosed as acute acalculous cholecystitis with SLE in the period from January 2012 to December 2016 at our hospital were included. They accepted 2 different conservative treatment strategies initially: the treatment using moxifloxacin (the antibiotic group), and the treatment using corticosteroid combined moxifloxacin (the corticosteroid group). Then clinical manifestations, laboratory features, and outcomes were analyzed.The study identified 22 women Han Chinese patients with the SLE history of 2.8 ±â€Š1.4 year. There was no significant difference in SLE history, Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2000), Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index (SLICC/ACR), hematologic examination results, and corticosteroid dosage between 2 groups. And there was no significant difference in the symptom of acute cholecystitis, duration of the symptoms, white blood level, and the thickness of gallbladder wall between 2 groups either. However, the SLEDAI-2000 of the corticosteroid group was lower than that of the antibiotic group (7.3 ±â€Š1.4 vs 10.7 ±â€Š3.0, P = .03), so was the SLICC/ACR (0.1 ±â€Š0.3 vs 0.3 ±â€Š0.5, P = .01). Moreover, total 11 of 12 patients were successfully treated in the corticosteroid group, only 1 patient got cholecystectomy because no improvement after conservative treatment. While 4 of 10 patients were successfully treated by moxifloxacin alone, 6 patients had to accept cholecystectomy in the antibiotic group. The rate of successful conservative treatment in the corticosteroid group was higher than that of the antibiotic group (P = .02). All patients were followed up at least 6 months, there was no statistical difference in the rate of recurrence of abdominal pain between 2 groups (P = .37).The corticosteroid plays an important role in the management of the acalculous cholecystitis patient with SLE, and it should be considered as a first line of treatment.


Assuntos
Colecistite Acalculosa/complicações , Colecistite Acalculosa/tratamento farmacológico , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Fluoroquinolonas/uso terapêutico , Lúpus Eritematoso Sistêmico/complicações , Colecistite Acalculosa/cirurgia , Adulto , Colecistectomia , Tratamento Conservador , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/cirurgia , Moxifloxacina , Resultado do Tratamento
13.
Pan Afr Med J ; 27: 8, 2017.
Artigo em Francês | MEDLINE | ID: mdl-28748010

RESUMO

Postoperative acalculous gangrenous cholecystitis is a serious and severe complication, especially in patients hospitalized in the Department of Reanimation. It occurs most often during vascular surgery or major digestive surgery, a polytrauma, in a context septic or in a context of shock. We report the case of a 74 year man who underwent surgery for femoral neck fracture. On the sixth postoperative day, he developed acute cholecystitis. Radiological examinations confirmed acalculous cholecystitis. After emergency cholecystectomy, anatomo-pathologic study confirmed the diagnosis of acalculous gangrenous cholecystitis.


Assuntos
Colecistite Acalculosa/etiologia , Colecistectomia/métodos , Colecistite Aguda/etiologia , Procedimentos Ortopédicos/efeitos adversos , Colecistite Acalculosa/diagnóstico , Colecistite Acalculosa/cirurgia , Idoso , Colecistite Aguda/diagnóstico , Colecistite Aguda/cirurgia , Fraturas do Colo Femoral/cirurgia , Gangrena/etiologia , Humanos , Masculino , Procedimentos Ortopédicos/métodos , Complicações Pós-Operatórias
14.
Clin Plast Surg ; 44(3): 567-571, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28576245

RESUMO

Although acute acalculous cholecystitis is uncommon in burn patients, this condition can be rapidly fatal due to delays in diagnosis and treatment and should always be considered in the differential diagnosis when burn patients become septic, develop abdominal pain, or have hemodynamic instability. This article reviews the use of percutaneous cholecystostomy in burn patients as both a diagnostic and therapeutic intervention.


Assuntos
Colecistite Acalculosa/etiologia , Colecistite Acalculosa/cirurgia , Queimaduras/complicações , Colecistostomia , Colecistite Acalculosa/diagnóstico , Diagnóstico Diferencial , Humanos
15.
Ann R Coll Surg Engl ; 99(1): e11-e12, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27502346

RESUMO

Peritoneal encapsulation is a rare congenital cause of bowel obstruction in children. We present the case of a 12-year-old male with severe dehydration and recurrent episodes of vomiting. This pathology should be considered in cases of bowel obstruction with a virgin abdomen.


Assuntos
Obstrução Intestinal/etiologia , Intestino Delgado/cirurgia , Peritônio/anormalidades , Colecistite Acalculosa/etiologia , Colecistite Acalculosa/cirurgia , Criança , Colecistectomia/métodos , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Intestino Delgado/diagnóstico por imagem , Laparotomia/métodos , Masculino , Fibrose Peritoneal/etiologia , Peritônio/cirurgia , Aderências Teciduais/congênito , Aderências Teciduais/cirurgia , Vômito/etiologia
16.
J Miss State Med Assoc ; 57(6): 174-6, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27526491

RESUMO

Herein we describe two cases of Cystoisospora belli infection of the gallbladder in patients with chronic abdominal pain and review the published literature to date. C. belli is an intracellular protozoan parasite that typically infects the small bowel of immunocompromised hosts. Little is known of the significance of C. belli infection of the gallbladder at this point as only four cases have been reported as yet, only one of which occurred in an immunocompetent patient. It is often treatable with antibiotics, and the patient's immune status, including HIV testing, should be investigated. Neither of the patients at our institution was found to be immunocompromised, and HIV-1/2 antibody testing was non-reactive in both.


Assuntos
Colecistite Acalculosa/patologia , Coccidiose/patologia , Sarcocystidae/isolamento & purificação , Colecistite Acalculosa/cirurgia , Adolescente , Adulto , Colecistectomia , Coccidiose/cirurgia , Feminino , Humanos
17.
Rev. chil. cir ; 68(1): 65-68, feb. 2016. ilus
Artigo em Espanhol | LILACS | ID: lil-780535

RESUMO

Abstract Introduction: The hepatitis A (HAV) is usually limited and common disease in children; very little is known about a calculous cholecystitis secondary to hepatitis because there are few reports worldwide. Case report: We report the case of a woman of 33 years who began with diarrhea, fever, jaundice and right upperquadrant pain, laboratory HAV IgM positive. No improvement of pain to medical treatment, we request anultrasound and cholangioresonance identifying signs of cholecystitis and edema of the wall; we performed laparoscopic cholecystectomy with symptom improvement. Secondary VHA cholecystitis is a rare entity, a medical or surgical treatment according to the patient’s clinical is needed to avoid complications.


Resumen Introducción: El virus de la hepatitis A (VHA) es por lo general una enfermedad limitada y frecuente en niños; se conoce muy poco sobre la colecistitis a calculosa secundaria a hepatitis ya que existen pocos reportes a nivel mundial. Caso clínico: Presentamos el caso de una mujer de 33 años la cual inició con diarrea, fiebre, ictericia y dolor en hipocondrio derecho, laboratorio con IgM positivo a VHA. Sin mejoría del dolora tratamiento médico, solicitamos un ultrasonido y colangio resonancia identificando datos de colecistitis y edema de pared; sometiéndola a colecistectomía con mejoría de los síntomas. La colecistitis secundaria a VHA es una entidad poco frecuente, es necesario un tratamiento médico o quirúrgico de acuerdo a la clínica del paciente para evitar complicaciones.


Assuntos
Humanos , Feminino , Adulto , Colecistectomia Laparoscópica , Colecistite Acalculosa/cirurgia , Colecistite Acalculosa/etiologia , Hepatite A/complicações , Colecistite Acalculosa/diagnóstico por imagem
18.
Surg Today ; 46(3): 309-12, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25904560

RESUMO

PURPOSE: To compare the safety of emergent laparoscopic cholecystectomy for acute acalculous cholecystitis (AAC) with surgery for acute calculous cholecystitis (ACC). METHODS: We retrospectively reviewed the perioperative records of 111 patients who underwent emergent laparoscopic cholecystectomy for acute cholecystitis under the care of the Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, between January 2010 and April 2014. Patients were divided into the AAC group (27 patients) and the ACC group (84 patients), and their perioperative outcomes were compared. RESULTS: Patients in the AAC group had significantly higher disease severity and American Society of Anesthesiologists physical status scores (p = 0.001 and 0.037, respectively), lower blood hemoglobin and albumin concentrations (p = 0.0005 and 0.017, respectively), and lower hematocrit and platelet count (p < 0.0001 and 0.040, respectively) than those in the ACC group. When we compared perioperative outcomes, we also found that patients in the AAC group were more likely to have received a blood transfusion (p = 0.002) and to have required conversion to open surgery (p = 0.008). There were no significant differences in morbidity, mortality or length of hospital stay. CONCLUSIONS: Early laparoscopic cholecystectomy is safe in acute acalculous as well as acute calculous cholecystitis.


Assuntos
Colecistite Acalculosa/cirurgia , Colecistectomia Laparoscópica , Colecistite Aguda/cirurgia , Idoso , Idoso de 80 Anos ou mais , Colecistectomia Laparoscópica/métodos , Estudos de Coortes , Emergências , Feminino , Humanos , Masculino , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
19.
Minerva Chir ; 71(2): 106-13, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26354326

RESUMO

BACKGROUND: Acute calcolous cholecystitis (ACC) is a very common pathology in western countries. The aim of our work was to assess the epidemiology of ACC and its treatment in Bergamo, a northern Italy province, during the last seventeen years. METHODS: A restrospective analysis, covering 1997 to 2013, was performed based on the administrative register of the province Health System. Only patients admitted for ACC were selected. From 1997 to 2013 were collected 8959 cases of ACC, mean age was 61.28, 51.5% were male. RESULTS: The incidence of ACC was 48/100.000 per year; the operation rate was 66%. Overall mortality was 0.7%, mean hospitalization time was 9.7 days. The treatment of ACC in Bergamo Province seemed to be acceptable and comparable to literature results. Over the last years, laparoscopy has become the standard treatment. CONCLUSIONS: This study outlined some criticisms on the selection's methodology sourcing data from administrative registers, raising questions about truthfulness of results and usefulness for health policy issues.


Assuntos
Colecistite Acalculosa/epidemiologia , Colecistite Acalculosa/cirurgia , Colecistectomia Laparoscópica , Colecistite Aguda/epidemiologia , Colecistite Aguda/cirurgia , Colecistite Acalculosa/complicações , Colecistite Acalculosa/mortalidade , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Colecistectomia Laparoscópica/métodos , Colecistectomia Laparoscópica/mortalidade , Colecistectomia Laparoscópica/estatística & dados numéricos , Colecistite Aguda/complicações , Colecistite Aguda/mortalidade , Conversão para Cirurgia Aberta/métodos , Conversão para Cirurgia Aberta/mortalidade , Conversão para Cirurgia Aberta/estatística & dados numéricos , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
20.
BMJ Case Rep ; 20152015 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-26561228

RESUMO

A 68-year-old man with expressive dysphasia presented with upper gastrointestinal haemorrhage, jaundice and abdominal pain. He was unable to tolerate ultrasound tranducer pressure. His oesophagogastroduodenoscopy (OGD) showed large blood clots in the stomach with blood trickling from the ampulla. An urgent CT angiogram demonstrated a 32 mm pseudoaneurysm within the gallbladder fossa. The patient subsequently underwent an endovascular embolisation of the pseudoaneurysm performed by the interventional radiology team.


Assuntos
Colecistite Acalculosa/complicações , Artéria Hepática/patologia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Colecistite Acalculosa/diagnóstico , Colecistite Acalculosa/diagnóstico por imagem , Colecistite Acalculosa/cirurgia , Idoso , Falso Aneurisma/diagnóstico , Falso Aneurisma/patologia , Falso Aneurisma/cirurgia , Angiografia/instrumentação , Diagnóstico Diferencial , Embolização Terapêutica/métodos , Endoscopia do Sistema Digestório/métodos , Procedimentos Endovasculares/métodos , Seguimentos , Artéria Hepática/diagnóstico por imagem , Humanos , Masculino , Resultado do Tratamento , Ultrassonografia
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