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2.
Medicine (Baltimore) ; 100(3): e24037, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546003

RESUMO

RATIONALE: Gallbladder polyps are common in the general population, but gallbladder metastasis of renal cell carcinoma (RCC) is very rare. In a patient with RCC diagnosed with a small gallbladder polyp that does not meet the traditional size criteria, the surgeon faces a dilemma of whether cholecystectomy should be performed given the possibility of metastasis. PATIENT CONCERNS: A 55-year-old man who had received a left nephrectomy for RCC presented with a gallbladder polyp that was noted at the time of the nephrectomy. Imaging showed the maximum diameter of the polyp had increased from 5 mm to 24 mm in the 40 months after the initial diagnosis. DIAGNOSIS: Pathological and immunohistology findings confirmed the gallbladder polyp as a metastasis of clear-cell RCC. INTERVENTIONS: : We performed a laparoscopic cholecystectomy. OUTCOMES: Even though the synchronous solitary gallbladder metastasis was left untreated and a cholecystectomy was not performed over the 40 months, no metastasis occurred in other sites. The patient is free from disease 10 months after the cholecystectomy. LESSONS: Solitary gallbladder metastasis of RCC may have more favorable outcomes than typical metastases. Although gallbladder metastasis of RCC occur rarely, it can occur, and any changes in gallbladder polyps in RCC patients should be managed under a strong suspicion of metastasis.


Assuntos
Carcinoma de Células Renais/secundário , Doenças da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/secundário , Neoplasias Renais/patologia , Pólipos/patologia , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/cirurgia , Colecistectomia/métodos , Vesícula Biliar/patologia , Vesícula Biliar/cirurgia , Doenças da Vesícula Biliar/etiologia , Doenças da Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/complicações , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/cirurgia , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Pólipos/etiologia , Pólipos/cirurgia
3.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462044

RESUMO

A 126-day female child presented with jaundice since day 7 of life. She was icteric and had hepatosplenomegaly. Radiological investigations revealed three extrahepatic and multiple intrahepatic biliary cysts, absent gall bladder and portal vein. These findings were confirmed on laparotomy. To the best of our knowledge, this is the first report of cystic biliary atresia associated with congenital absence of portal vein.


Assuntos
Atresia Biliar/diagnóstico , Anormalidades Congênitas/diagnóstico , Vesícula Biliar/anormalidades , Veia Porta/anormalidades , Atresia Biliar/etiologia , Atresia Biliar/cirurgia , Anormalidades Congênitas/cirurgia , Evolução Fatal , Feminino , Vesícula Biliar/cirurgia , Humanos , Lactente
4.
BMJ Case Rep ; 14(1)2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33408103

RESUMO

A 79-year-old woman presented with postprandial epigastric pain. She had normal vital signs, inflammatory markers and liver function tests. Ultrasound and CT of the abdomen demonstrated features consistent with acute cholecystitis. Her medical comorbidities and extensive abdominal surgical history prompted the decision to treat non-operatively. Despite optimal medical management, worsening abdominal pain and uptrending inflammatory markers developed. She underwent an emergency laparoscopy which revealed a necrotic gallbladder secondary to an anticlockwise complete gallbladder torsion; a rare condition associated with significant morbidity and mortality if managed non-operatively. Laparoscopic cholecystectomy was achieved without complication and the patient had an uneventful recovery. Preoperative diagnosis of torsion of the gallbladder is difficult. However, there are certain patient demographics and imaging characteristics that can help surgeons differentiate it from acute cholecystitis; a condition which can be safely managed non-operatively in selected patients. The differentiating features are elaborated on in this case report.


Assuntos
Dor Abdominal/etiologia , Colecistectomia Laparoscópica , Colecistite Aguda/diagnóstico , Vesícula Biliar/patologia , Anormalidade Torcional/diagnóstico , Administração Intravenosa , Idoso , Analgésicos/administração & dosagem , Antibacterianos/administração & dosagem , Colecistite Aguda/tratamento farmacológico , Colecistite Aguda/etiologia , Tratamento Conservador , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Humanos , Necrose/diagnóstico , Necrose/cirurgia , Período Pós-Prandial , Tomografia Computadorizada por Raios X , Anormalidade Torcional/complicações , Anormalidade Torcional/cirurgia , Ultrassonografia
5.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334767

RESUMO

An 83-year-old man with a history of chronic myelogenous leukaemia in remission maintained with bosutinib presented with new-onset fevers. He denied pain and had no other focal symptoms. Ultrasound imaging revealed mild gallbladder wall thickening. Non-contrasted CT revealed right upper quadrant inflammation of indeterminate source. The diagnosis of acalculous cholecystitis was made on the third day when a CT with oral contrast demonstrated a remarkably inflamed biliary tree. The gallbladder was surgically removed and found to be necrotic. The case highlights an unusual presentation for a well-known condition. Both ultrasound and CT have limited diagnostic sensitivity for acalculous cystitis. This case adds to existing literature to support development of acalculous cholecystitis in non-critically ill patients. Clinicians should maintain awareness of this condition among patients presenting to the hospital or clinic with abdominal pain. Careful discussion with radiology and surgery is indicated to guide diagnostic testing when initial imaging results are indeterminate.


Assuntos
Colecistite Acalculosa/diagnóstico , Escherichia coli/isolamento & purificação , Febre/microbiologia , Vesícula Biliar/patologia , Colecistite Acalculosa/complicações , Colecistite Acalculosa/microbiologia , Colecistite Acalculosa/terapia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Colecistectomia , Quimioterapia Combinada , Febre/sangue , Febre/imunologia , Febre/terapia , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/microbiologia , Vesícula Biliar/cirurgia , Humanos , Masculino , Necrose/complicações , Necrose/diagnóstico , Necrose/microbiologia , Necrose/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia
6.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370977

RESUMO

Neuroendocrine neoplasms of the gallbladder occur infrequently, with the diagnosis being incidental in most cases. We present a case of an 81-year-old African American woman who initially presented with acute suppurative cholecystitis, found on pathology to have a moderately differentiated infiltrating adenocarcinoma. A partial hepatic resection with periportal lymph node dissection was planned which was subsequently aborted intraoperatively due to the presence of diffuse carcinomatosis. Pathology of the cancerous lesions revealed neuroendocrine carcinoma. Gallbladder neuroendocrine tumours demonstrate no specific clinical features. Given its often late presentation, neuroendocrine tumours of the gallbladder pose a therapeutic and prognostic challenge.


Assuntos
Carcinoma Neuroendócrino/diagnóstico , Colecistite Aguda/etiologia , Neoplasias da Vesícula Biliar/diagnóstico , Vesícula Biliar/patologia , Neoplasias Peritoneais/diagnóstico , Idoso de 80 Anos ou mais , Carcinoma Neuroendócrino/secundário , Carcinoma Neuroendócrino/terapia , Colecistectomia Laparoscópica , Colecistite Aguda/cirurgia , Evolução Fatal , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/complicações , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/terapia , Cuidados Paliativos na Terminalidade da Vida , Humanos , Diagnóstico Ausente , Estadiamento de Neoplasias , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/terapia , Tomografia Computadorizada por Raios X
7.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370988

RESUMO

Cholecystocolonic fistula with associated idiopathic megabowel (megacolon and megarectum) is a rare presentation as acute large bowel obstruction. Frequently presenting with chronic constipation, acute bowel obstruction is rarely encountered in the presence of concomitant cholecystocolonic fistula. This presents diagnostic and management difficulties with no consensus on appropriate surgical approach. This case highlights the outcomes following emergency total colectomy and subtotal cholecystectomy as a single-stage procedure for a 68-year-old man presenting with cholecystocolonic fistula secondary to idiopathic megabowel as acute large bowel obstruction.


Assuntos
Fístula Biliar/etiologia , Doenças da Vesícula Biliar/etiologia , Fístula Intestinal/etiologia , Obstrução Intestinal/etiologia , Megacolo/complicações , Doenças Retais/complicações , Idoso , Fístula Biliar/diagnóstico , Fístula Biliar/cirurgia , Colecistectomia , Colectomia , Colo/diagnóstico por imagem , Colo/cirurgia , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Doenças da Vesícula Biliar/diagnóstico , Doenças da Vesícula Biliar/cirurgia , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/cirurgia , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/cirurgia , Masculino , Megacolo/diagnóstico , Megacolo/cirurgia , Doenças Retais/diagnóstico , Doenças Retais/cirurgia , Reto/diagnóstico por imagem , Reto/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
BMJ Case Rep ; 13(12)2020 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-33323423

RESUMO

A 78-year-old man presented to the hospital with acute right upper quadrant pain, fever and nausea. A focused abdominal ultrasound and abdominal CT scan were performed demonstrating an acute calculous cholecystitis with gallbladder perforation. Although a CT-guided cholecystostomy was performed and a pericholecystic abscess was relieved promptly, the patient developed a cholecystocutaneous fistula in the right hypochondriac region. A cholecystocutaneous fistula is an extremely rare complication that may occur in patients with acute calculous or acalculous cholecystitis, chronic gallstone disease, gallbladder carcinoma or prior hepatobiliary surgery.


Assuntos
Fístula Biliar/etiologia , Colecistite Aguda/complicações , Fístula Cutânea/etiologia , Idoso , Fístula Biliar/diagnóstico por imagem , Fístula Biliar/terapia , Colecistite Aguda/cirurgia , Fístula Cutânea/diagnóstico por imagem , Fístula Cutânea/terapia , Drenagem , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Humanos , Masculino , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos
9.
Medisan ; 24(6) ilus
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1143271

RESUMO

Se describe el caso clínico de una paciente de 95 años de edad, quien acudió al Cuerpo de Guardia del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba por presentar dolor abdominal difuso, de comienzo súbito con 48 horas de evolución, acompañado de náuseas y vómitos de escasa cuantía y de coloración oscura, así como ligera distención abdominal, sin expulsión de heces ni gases. Se decidió su ingreso para tratamiento quirúrgico urgente, con el diagnóstico presuntivo de oclusión intestinal. Durante la cirugía se encontró la vesícula distendida con su pedículo torcido. Se realizó colecistectomía típica. La paciente evolucionó satisfactoriamente y no presentó complicaciones posoperatorias.


The case report of a 95 years patient is described, she went to the emergency department of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba due to a diffuse abdominal pain, of sudden beginning with 48 hours of clinical course, accompanied by nauseas and vomits of scarce quantity and dark color, as well as slight abdominal distention, without expulsion of stools neither gases. Her admission was decided for emergency surgical treatment, with the presumptive diagnosis of intestinal occlusion. During the surgery the distended gallbladder with bent pedicle was found. A typical cholecystectomy was carried out. The patient had a favorable clinical course and she didn't present postoperative complications.


Assuntos
Colecistectomia , Vesícula Biliar/cirurgia , Anormalidade Torcional , Pessoa de Meia-Idade
10.
Isr Med Assoc J ; 9(22): 472-475, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32954691

RESUMO

BACKGROUND: The safe completion of cholecystectomy is dependent on proper identification and secure closure of the cystic duct. Effecting this closure poses a great challenge when inflammatory changes obscure the anatomy. Subtotal cholecystectomy allows for near complete removal of the gallbladder and complete evacuation of the stones while avoiding dissection in the hazardous area. OBJECTIVES: To describe experience with laparoscopic subtotal cholecystectomy. METHODS: Subtotal cholecystectomy was performed when the critical view of safety could not be achieved. Surgical technique was similar in all cases and included opening the Hartmann's pouch, removing stones obstructing the gallbladder outlet, and identifying the opening of the cystic duct, as well as circumferential transection of the gallbladder neck, closure of the gallbladder stump, and excision of the gallbladder fundus. Data retrieved from patient charts included demographics, pre-operative history, operative and postoperative course, and late complications. No bile duct injuries were observed in this series. RESULTS: A total of 53 patients underwent laparoscopic subtotal cholecystectomy (2010-2018). Ten patients were operated during the acute course of the disease and 43 electively. Acute cholecystitis was the leading cause for gallbladder removal. Cholecystostomy tube was placed in 18 patients during acute hospitalization. The gallbladder remnant was closed and a drain was placed in most patients. Of the 53 patients, 42 had an uneventful postoperative course. CONCLUSIONS: Laparoscopic subtotal cholecystectomy is an effective surgical technique to avoid bile duct injury when the cystic duct cannot safely be identified. Subtotal cholecystectomy has acceptable morbidity and obviates the need for conversion in these difficult cases.


Assuntos
Colecistectomia Laparoscópica/métodos , Colecistite Aguda/cirurgia , Vesícula Biliar/cirurgia , Idoso , Feminino , Vesícula Biliar/fisiopatologia , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
12.
Khirurgiia (Mosk) ; (6): 49-52, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32573532

RESUMO

OBJECTIVE: To study the incidence of gallbladder polyps and the possibilities of modern methods of diagnosis and surgical treatment of this disease. MATERIAL AND METHODS: There were 42 laparoscopic cholecystectomies in patients with diagnosed gallbladder polyps. The polyps were diagnosed preoperatively. Intraoperative diagnosis during surgery for gallstone disease was observed in 3 cases. A comparative analysis of preoperative examination did not reveal any advantages of certain diagnostic approach. RESULTS: Hyperplastic polyp was the most common type (n=20, 47.6%), adenomatous polyps occurred in 19 (45.3%) cases, cholesteric polyps - in 3 (7.1%) patients. All patients had signs of chronic inflammation of the gallbladder wall with its infiltration by lymphocytes and histiocytes. CONCLUSION: Further studies with clear criteria for the diagnosis of gallbladder polyps including ones for determining true polyps, precancerous and malignant polyps are required.


Assuntos
Doenças da Vesícula Biliar/cirurgia , Pólipos/cirurgia , Colecistectomia Laparoscópica , Colecistite/cirurgia , Doença Crônica , Vesícula Biliar/cirurgia , Doenças da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Pólipos/diagnóstico , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/cirurgia
13.
Rev. cir. (Impr.) ; 72(3): 262-266, jun. 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1115553

RESUMO

Resumen El cáncer de vesícula es infrecuente a nivel mundial, a diferencia de su alta incidencia en Chile. Su pronóstico es malo en general, y dependerá de su forma de presentación, siendo mejor en los casos diagnosticados después de una colecistectomía laparoscópica por patología benigna. La reintervención, que incluye la resección hepática y linfadenectomía, es el pilar de la terapia curativa en esta neoplasia. Presentamos la descripción de la técnica quirúrgica realizada en los pacientes con cáncer de vesícula de diagnóstico incidental, en el Servicio de Cirugía de Clínica Alemana de Santiago y en el Hospital de la Fuerza Aérea de Chile. El abordaje laparoscópico representa una alternativa quirúrgica válida en el tratamiento de pacientes con cáncer de vesícula biliar diagnosticados después de la colecistectomía. La estandarización de la técnica debiera contribuir a su mayor empleo y a la obtención de buenos resultados desde un punto de vista oncológico.


Gallbladder cancer is considered an infrequent disease but in Chile has a higher incidence. Prognostic is considered dismal except in those patients in whom the diagnosis is performed after the cholecystectomy specimen study. Reoperation with gallbladder bed resection and lymphadenectomy is considered the treatment in patients with incidental cases. We show the way this operation is performed in Clinica Alemana of Santiago and in the Air Force Hospital. The laparoscopic approach is an alternative to those patients in whom the diagnosis was done after the cholecystectomy. Laparoscopy allows to accomplish same objectives and to obtain identical results that the open approach. The technical standardization should contribute to spread its employment and to improve the results.


Assuntos
Humanos , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/cirurgia , Excisão de Linfonodo/métodos , Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Laparoscopia , Gerenciamento Clínico , Achados Incidentais , Excisão de Linfonodo/normas
14.
Artigo em Inglês | MEDLINE | ID: mdl-32359684

RESUMO

Non-obstetric surgery during pregnancy is required in 0.75-2% of pregnancies. Physiologic changes during pregnancy, both hormonal and anatomic, can have interactions with surgery and anesthesia. Indication, timing as well as risks of anesthesia and surgery should be considered in surgical decision making. The health status of the mother should always be put first. A preoperative multidisciplinary approach, also including an obstetrician and neonatologist, is mandatory. Delay in diagnosis and treatment carry risks of complications in all septic visceral indications. Considerations should be individualized.


Assuntos
Vesícula Biliar/cirurgia , Doenças Inflamatórias Intestinais/cirurgia , Complicações na Gravidez/cirurgia , Feminino , Vesícula Biliar/patologia , Humanos , Gravidez
16.
J Gastroenterol Hepatol ; 35(10): 1821-1827, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32267555

RESUMO

BACKGROUND AND AIM: Lumen-apposing metal stent is widely used for endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) nowadays but not approved in many countries and might be unsuitable for elective laparoscopic cholecystectomy (LC) because of its large enterocholecysto fistula. A combination of double pigtail plastic stent (DPPS) and naso-cystic tube (NCT) could overcome these problems. The aim of this study was to estimate the efficacy and safety of this method in patients with acute cholecystitis unfit for urgent cholecystectomy both as bridge to surgery and palliation. METHODS: This was a prospective, single-center feasibility study. EUS-GBD was performed with a 7Fr DPPS followed by an NCT placement. NCT was removed after 1 week. LC was performed 2 or 3 months after EUS-GBD in eligible patients. In patients who did not underwent cholecystectomy, DPPS was left in place. RESULTS: Twenty-three patients were enrolled. Both technical and clinical success rates were 96% (22/23). Early adverse events rate was 13% (3/23), including one bile peritonitis, one intraperitoneal abscess, and one melena. LC was attempted in 12 patients, and conversion to open cholecystectomy was required in three (25%). Neither recurrence of cholecystitis nor late adverse event occurred during 6 months of follow up in 10 patients who did not undergo cholecystectomy. CONCLUSION: EUS-GBD with a combination of DPPS and NCT is considered an effective and safe technique both as bridge to surgery and palliation.


Assuntos
Colecistectomia Laparoscópica/métodos , Colecistite Aguda/diagnóstico por imagem , Colecistite Aguda/cirurgia , Drenagem/métodos , Vesícula Biliar/cirurgia , Cirurgia Assistida por Computador/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Endossonografia/métodos , Estudos de Viabilidade , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Ultrassonografia de Intervenção
17.
Transplant Proc ; 52(5): 1518-1520, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32299704

RESUMO

BACKGROUND: Anatomic variations are well known in the liver hilum. A rare precholecystic, preduodenal, prepancreatic portal vein is described as found in a liver transplant candidate. Precholecystic location of portal vein is an exceptional finding and does not seem to have been previously described. It is associated with a preduodenal portal vein. Its position is challenging, as its surface can be mistaken with the gallbladder wall. We present the case of a patient candidate to liver transplantation. In the preoperative studies, a portal thrombosis was suspected, with recanalization by collaterals, but also a malformation was suggested. The patient had a primary biliary cirrhosis. Other findings included agenesis of inferior vena cava on the right side. During operation, the portal vein was found over the gallbladder and fixed to it, making it at first difficult to distinguish one from the other. CONCLUSIONS: A precholecystic portal vein is a rare finding that poses a challenge for the surgeon. It must be ruled out in the preoperative workout.


Assuntos
Vesícula Biliar/cirurgia , Transplante de Fígado/métodos , Pâncreas/cirurgia , Veia Porta/anormalidades , Veia Porta/cirurgia , Variação Anatômica , Feminino , Vesícula Biliar/anatomia & histologia , Humanos , Hepatopatias/complicações , Hepatopatias/cirurgia , Pessoa de Meia-Idade , Pâncreas/anatomia & histologia , Veia Cava Inferior/cirurgia , Trombose Venosa/congênito , Trombose Venosa/cirurgia
18.
Acta Radiol ; 61(11): 1452-1462, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32228032

RESUMO

BACKGROUND: Previous studies evaluating predictive factors for the conversion from laparoscopic to open cholecystectomy have reported conflicting conclusions. PURPOSE: To create a risk assessment model to predict the conversion from laparoscopic to open cholecystectomy in patients with acute calculous cholecystitis. MATERIAL AND METHODS: A retrospective review of patients with acute calculous cholecystitis with available preoperative contrast-enhanced computed tomography (CT) findings who underwent laparoscopic cholecystectomy was performed. Forty-four parameters-including demographics, clinical history, laboratory data, and CT findings-were analyzed. RESULTS: Among the included 581 patients, conversion occurred in 113 (19%) cases. Multivariate analysis identified obesity (odd ratio [OR] 2.58, P = 0.04), history of abdominal surgery (OR 1.78, P = 0.03), and prolonged prothrombin time (OR 1.98, P = 0.03) as predictors of conversion. In preoperative CT findings, the absence of gallbladder wall enhancement (OR 3.15, P = 0.03), presence of a gallstone in the gallbladder infundibulum (OR 2.11, P = 0.04), and inflammation of the hepatic pedicle (OR 1.71, P = 0.04) were associated with conversion. Inter-observer agreement for CT study interpretation was very good (range 0.81-1.00). A model was created to calculate the risk for conversion, with an area under the receiver operating characteristic curve of 0.87. The risk for conversion, estimated based on the number of factors identified, was in the range of 5.3% (with one factor) to 86.4% (with six factors). CONCLUSION: Obesity, history of abdominal surgery, prolonged prothrombin time, absence of gallbladder wall enhancement, presence of a gallstone in the gallbladder infundibulum, and inflammation of the hepatic pedicle are associated with conversion of laparoscopic to open cholecystectomy.


Assuntos
Colecistectomia Laparoscópica/métodos , Colecistite Aguda/diagnóstico por imagem , Colecistite Aguda/cirurgia , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Adulto Jovem
19.
J Vasc Interv Radiol ; 31(5): 801-807, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32305242

RESUMO

PURPOSE: To assess the short-term safety and efficacy of gallbladder cryoablation in high-risk patients. MATERIALS AND METHODS: A single-center, retrospective review of clinical and imaging follow-up from patients who were referred for gallbladder cryoablation between August 2018 and July 2019 was performed. All patients had serious pre-procedural comorbidities and were unacceptable surgical candidates (mean age, 52.5 years; mean American Society of Anesthesiologists score, 3.67). Primary efficacy measures included technical success, absence of symptoms after cholecystostomy tube removal, and imaging evidence of cystic duct obstruction and gallbladder involution. The primary safety measure was the absence of Society of Interventional Radiology moderate or greater adverse events. RESULTS: Technical success was 86%, with 1 of 7 patients unable to undergo cryoablation because of adhesions preventing hydrodissection of the colon away from the gallbladder. Mean duration of clinical follow-up after discharge was 278 days (range, 59-498 days). Abdominal pain was absent in all patients after ablation. Cholecystostomy tubes were removed immediately after ablation (n = 5) or on post-procedure day 11 (n = 1). Computed tomography or magnetic resonance imaging was obtained at 1-3 months (n = 6), 4-6 months (n = 4), and 6-12 months (n = 5) after the procedure and demonstrated gallbladder involution in 5 of 6 patients. One patient had asymptomatic distention of the gallbladder on follow-up imaging. Hepatobiliary iminodiacetic acid scans were completed in 5 of 6 patients 1 month after ablation and demonstrated cystic duct occlusion in all 5 patients. One moderate adverse event (infection) and 1 life-threatening adverse event (hemorrhage) occurred. CONCLUSIONS: Gallbladder cryoablation might be a viable treatment option for high-risk patients with gallbladder disease and warrants further investigation.


Assuntos
Colecistite/cirurgia , Criocirurgia , Vesícula Biliar/cirurgia , Adulto , Idoso , Colecistectomia/efeitos adversos , Colecistite/diagnóstico por imagem , Doença Crônica , Contraindicações de Procedimentos , Criocirurgia/efeitos adversos , Feminino , Vesícula Biliar/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
20.
S D Med ; 73(3): 102-105, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32142227

RESUMO

INTRODUCTION: Gallbladder trauma is an uncommon occurrence, most commonly found incidentally at the time of laparotomy for associated injuries following abdominal trauma. It is even more rare in blunt abdominal trauma, with one of the rarest forms being an isolated injury to the gallbladder. Awareness for this type of injury should not be forgotten by emergency personal when evaluating someone with a history of recent trauma. CASE DESCRIPTION: A 44-year-old male who works as a construction worker fell from a roof, landing on his right side. Upon evaluation by the emergency department, emergency personnel combined the history, abnormal laboratory values and imaging including ultrasound (U/S) and computed tomography (CT) to assess and diagnose a concern for gallbladder perforation. He was treated with a diagnostic laparoscopy, laparoscopic cholecystectomy, and intraoperative choleangiogram. The patient tolerated the procedure well and discharged home on postoperative day 1. DISCUSSION: Gallbladder trauma can be seen in all population types. As the gallbladder is fairly protected, it is rare to have an isolated injury. A detailed history as described can tip off practitioners to the diagnosis, but is also missed or delayed due to occasionally vague symptoms. Imaging studies can be used adjunctively to assist in diagnosis and may include CT, U/S, color Doppler, or HIDA scans. These can also fail to give a diagnosis leading to a missed injury and further morbidity and mortality. Perforated gallbladders can safely be treated laparoscopically as well as other options depicted. CONCLUSION: Awareness of isolated and rare injuries in trauma, such as those to the gallbladder, enables many types of emergency personnel to recognize and treat patients and consequently prevent the morbidity and mortality of a missed injury.


Assuntos
Traumatismos Abdominais , Vesícula Biliar , Ferimentos não Penetrantes , Traumatismos Abdominais/complicações , Adulto , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/lesões , Vesícula Biliar/cirurgia , Humanos , Masculino , Ruptura , Ultrassonografia
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