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Hagos HH, Gebremichael YL, Reta BK, Woldu TB, Yohala HF, Kidanu GT. A case of acute neonatal acalculous cholecystitis: A case report. Int J Surg Case Rep 2025; 130:111298. [PMID: 40233641 PMCID: PMC12019075 DOI: 10.1016/j.ijscr.2025.111298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2025] [Revised: 04/08/2025] [Accepted: 04/12/2025] [Indexed: 04/17/2025] Open
Abstract
INTRODUCTION Cholecystitis is inflammatory condition of the gallbladder, usually associated with gallstones. It has serious medical complications if left untreated. Both calculous and acalculous cholecystitis are relatively well defined in older children. However, acute acalculous cholecystitis in neonates is exceedingly rare entity and is not well defined in the literature. PRESENTATION OF CASE We reported a 3-day old, male neonate, weighing 3100 g, born to 26-year-old para II mother at term gestation who brought with the complaint of repeated vomiting of every breast fed for two days. On examination he had deranged vital signs. Abdominal Ultrasound showed features of acute cholecystitis. He had received intravenous fluid and first line antibiotics, improved and discharged after 7 days of hospital stay. DISCUSSION Acute acalculous cholecystitis is the inflammation of the gallbladder. In neonates it commonly occurs in association with sepsis, prematurity, medications and bacterial infections (Escherichia coli) among others. It is also associated with congenital anomalies. Unlike older children neonates present more with variable clinical manifestations and thus the diagnosis may be challenging based on clinical presentation. Moreover, the diagnosis of acalculous cholecystitis is usually obtained through abdominal ultrasonography. The management of acute acalculous neonatal cholecystitis can be conservative and operative. CONCLUSION Even though it is rare, NAC shall be considered in the list of differentials in neonates who presented with features of sepsis and acute abdomen, particularly those with intractable vomiting.
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Affiliation(s)
- Hindeya Hailu Hagos
- Aksum University, College of Health Science, Department of Pediatrics and Child Health, Aksum, Ethiopia
| | - Yemane Leake Gebremichael
- Aksum University, College of Health Science, Department of Pediatrics and Child Health, Aksum, Ethiopia.
| | - Birhanu Kassie Reta
- Aksum University, College of Health Science, Department of Pathology, Aksum, Ethiopia
| | - Tiegist Bahta Woldu
- Aksum University, College of Health Science, Department of Pharmacy, Aksum, Ethiopia
| | - Hadush Fitsum Yohala
- Aksum University, College of Health Science, Department of Surgery, Aksum, Ethiopia
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Habib MB, Albandak M, Osman MH, Abbarh S, Sawaf B, Alastal Y, Arabi A. Acalculous Cholecystitis: The Unexpected Mask of De Novo Heart Failure. Clin Case Rep 2025; 13:e70324. [PMID: 40114992 PMCID: PMC11923240 DOI: 10.1002/ccr3.70324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Revised: 01/29/2025] [Accepted: 02/25/2025] [Indexed: 03/22/2025] Open
Abstract
Acute acalculous cholecystitis refers to inflammation of the gallbladder without the presence of gallstones or obstruction of the cystic duct. Heart failure is recognized for causing congestive hepatopathy and can lead to gallbladder swelling, often challenging to distinguish from acalculous cholecystitis. Here, we present a case of a patient whose symptoms initially resembled acalculous cholecystitis but were instead caused by acute severe heart failure and cardiogenic shock. Maintaining a broad differential diagnosis, including decompensated heart failure, is essential when evaluating cases resembling acalculous cholecystitis.
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Affiliation(s)
- Mhd Baraa Habib
- Department of Cardiology Hamad Medical Corporation Doha Qatar
| | - Maram Albandak
- Department of Internal Medicine University of Toledo Medical Center Toledo Ohio USA
| | - Mhd Husam Osman
- Department of Internal Medicine Hamad Medical Corporation Doha Qatar
| | - Shahem Abbarh
- Department of Internal Medicine MedStar Health Baltimore Maryland USA
| | - Bisher Sawaf
- Department of Internal Medicine University of Toledo Medical Center Toledo Ohio USA
| | - Yaseen Alastal
- Department of Gastroenterology University of Toledo Medical Center Toledo Ohio USA
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3
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Fung C, Spychka R, Noorelahi R, Vijay K, Fetzer DT. Ultrasound of the gallbladder: not the same bag of tricks. Abdom Radiol (NY) 2025; 50:720-733. [PMID: 39207516 DOI: 10.1007/s00261-024-04530-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/07/2024] [Accepted: 08/12/2024] [Indexed: 09/04/2024]
Abstract
Imaging evaluation of the gallbladder is a fundamental skill in the majority of radiology practice. Due to ease of accessibility, low cost, lack of ionizing radiation, and excellent spatial resolution, ultrasound is often the first imaging modality used to evaluate the gallbladder. In this invited article we review and update how ultrasound can evaluate common pathologies including gallbladder polyps, tumefactive sludge, adenomyomatosis, and acute cholecystitis. We also discuss the role of Doppler, microvascular flow imaging, and contrast enhanced ultrasound in the sonographic assessment of the gallbladder.
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Affiliation(s)
- Christopher Fung
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, 8440-112 Street NW, Edmonton, AB, T6G 2B7, Canada.
| | - Ryan Spychka
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, 8440-112 Street NW, Edmonton, AB, T6G 2B7, Canada
| | - Razan Noorelahi
- UT Southwestern Medical Center, 5323 Harry Hines Blvd, EB1.300, Dallas, TX, 75390-9065, USA
| | - Kanupriya Vijay
- UT Southwestern Medical Center, 5323 Harry Hines Blvd, EB1.300, Dallas, TX, 75390-9065, USA
| | - David T Fetzer
- UT Southwestern Medical Center, 5323 Harry Hines Blvd, EB1.300, Dallas, TX, 75390-9065, USA
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David Y, Kakked G, Confer B, Shah R, Khara H, Diehl DL, Krafft MR, Shah-Khan SM, Nasr JY, Benias P, Trindade A, Muniraj T, Aslanian H, Chahal P, Rodriguez J, Adler DG, Dubroff J, De Latour R, Tzimas D, Khanna L, Haber G, Goodman AJ, Hoerter N, Pandey N, Bakhit M, Kowalski TE, Loren D, Chiang A, Schlachterman A, Nieto J, Deshmukh A, Ichkhanian Y, Khashab MA, El Halabi M, Kwon RS, Prabhu A, Hernandez-Lara A, Storm A, Berzin TM, Poneros J, Sethi A, Gonda TA, Kushnir V, Cosgrove N, Mullady D, Al-Shahrani A, D'Souza L, Buscaglia J, Bucobo JC, Rolston V, Kedia P, Kasmin F, Nagula S, Kumta NA, DiMaio C. US multicenter outcomes of endoscopic ultrasound-guided gallbladder drainage with lumen-apposing metal stents for acute cholecystitis. Endosc Int Open 2025; 13:a24955542. [PMID: 39958659 PMCID: PMC11827723 DOI: 10.1055/a-2495-5542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 11/25/2024] [Indexed: 02/18/2025] Open
Abstract
Background and study aims EUS-guided gallbladder drainage (EUS-GBD) using lumen apposing metal stents (LAMS) has excellent technical and short-term clinical success for acute cholecystitis (AC). The goals of this study were to determine the long-term clinical outcomes and adverse events (AEs) of EUS-GBD with LAMS. Patients and methods A multicenter, retrospective study was conducted at 18 US tertiary care institutions. Inclusion criteria: any AC patient with attempted EUS-GBD with LAMS and minimum 30-day post-procedure follow-up. Long-term clinical success was defined as absence of recurrent acute cholecystitis (RAC) > 30 days and long-term AE was defined as occurring > 30 days from the index procedure. Results A total of 109 patients were included. Technical success was achieved in 108 of 109 (99.1%) and initial clinical success in 106 of 109 (97.2%). Long-term clinical success was achieved in 98 of 109 (89.9%) over a median follow-up of 140 days (range 30-1188). On multivariable analysis (MVA), acalculous cholecystitis (odds ratio [OR] 15.93, 95% confidence interval [CI] 1.22-208.52, P = 0.04) and the occurrence of a LAMS-specific AE (OR 63.60, 95% CI 5.08-799.29, P <0.01) were associated with RAC. AEs occurred in 38 of 109 patients (34.9%) at any time, and in 10 of 109 (9.17%) > 30 days from the index procedure. Most long-term AEs (7 of 109; 6.42%) were LAMS-specific. No technical or clinical factors were associated with occurrence of AEs. LAMS were removed in 24 of 109 patients (22%). There was no difference in RAC or AEs whether LAMS was removed or not. Conclusions EUS-GBD with LAMS has a high rate of long-term clinical success and modest AE rates in patients with AC and is a reasonable destination therapy for high-risk surgical candidates.
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Affiliation(s)
- Yakira David
- Gastroenterology, Mayo Clinic College of Medicine and Science, Rochester, United States
| | - Gaurav Kakked
- Rush University Medical Center, Chicago, United States
| | - Bradley Confer
- Gastroenterology and Nutrition, Geisinger Medical Center, Danville, United States
| | - Ruchit Shah
- Geisinger Medical Center, Danville, United States
| | | | - David L Diehl
- Gastroenterology and Nutrition, Geisinger Medical Center, Danville, United States
| | | | - Sardar M Shah-Khan
- Gastroenterology, Rutgers Robert Wood Johnson Medical School New Brunswick, New Brunswick, United States
| | - John Y Nasr
- Digestive Diseases, West Virginia University School of Medicine, Morgantown, United States
| | | | - Arvind Trindade
- North Shore Long Island Jewish Medical Center, New Hyde Park, United States
| | | | - Harry Aslanian
- Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, United States
| | | | | | - Douglas G Adler
- Gastroenterology, University of Utah School of Medicine, Salt Lake City, United States
| | - Jason Dubroff
- University of Utah Health, Salt Lake City, United States
| | | | | | | | | | - Adam J Goodman
- Gastroenterology, NYU Langone Medical Center, New York, United States
| | - Nicholas Hoerter
- Icahn School of Medicine at Mount Sinai, New York, United States
| | | | - Mena Bakhit
- Brown University Warren Alpert Medical School, Providence, United States
| | - Thomas E. Kowalski
- Gastroenterology, Thomas Jefferson University - Center City Campus, Philadelphia, United States
| | - David Loren
- Fox Chase Cancer Center, Philadelphia, United States
| | - Austin Chiang
- Thomas Jefferson University Hospital JeffSTAT Education Center, Philadelphia, United States
| | - Alexander Schlachterman
- Division of Gastroenterology, Hepatology & Nutrition, University of Florida, Gainesville, United States
| | - Jose Nieto
- Gastroenterology, Borland-Groover Clinic, Jacksonville, United States
| | | | | | - Mouen A. Khashab
- Gastroenterology, Johns Hopkins Hospital, Baltimore, United States
| | | | | | - Anoop Prabhu
- Roswell Park Comprehensive Cancer Center, Buffalo, United States
| | | | - Andrew Storm
- Mayo Foundation for Medical Education and Research, Rochester, United States
| | - Tyler M. Berzin
- Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, United States
| | - John Poneros
- Digestive and Liver Diseases, Columbia University Medical Center, New York, United States
| | - Amrita Sethi
- Columbia Presbyterian Medical Center, New York, United States
| | - Tamas A Gonda
- Digestive and Liver Diseases, Columbia University Medical Center, NYC, United States
| | | | - Natalie Cosgrove
- Gastroenterology & Hepatology, Thomas Jefferson University, Philadelphia, United States
| | - Daniel Mullady
- Washington University in St Louis, St Louis, United States
| | | | - Lionel D'Souza
- Stony Brook University Hospital, Stony Brook, United States
| | - Jonathan Buscaglia
- Division of Gastroenterology, State University of New York, Stony Brook, United States
| | | | - Vineet Rolston
- Memorial Sloan Kettering Cancer Center, New York, United States
| | - Prashant Kedia
- Gastroenterology, Methodist Dallas Medical Center, Dallas, United States
| | - Franklin Kasmin
- HCA Florida Aventura Hospital and Medical Center, Aventura, United States
| | - Satish Nagula
- Medicine, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Nikhil A Kumta
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Christopher DiMaio
- Catholic Health St Francis Hospital & Heart Center, Roslyn, United States
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Jin Y, Xing J, Dai C, Jin L, Zhang W, Tao Q, Hou M, Li Z, Yang W, Feng Q, Wang H, Yu Q. NK cell exhaustion in Wilson's disease revealed by single-cell RNA sequencing predicts the prognosis of cholecystitis. eLife 2024; 13:RP98867. [PMID: 39854622 PMCID: PMC11684787 DOI: 10.7554/elife.98867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2025] Open
Abstract
Metabolic abnormalities associated with liver disease have a significant impact on the risk and prognosis of cholecystitis. However, the underlying mechanism remains to be elucidated. Here, we investigated this issue using Wilson's disease (WD) as a model, which is a genetic disorder characterized by impaired mitochondrial function and copper metabolism. Our retrospective clinical study found that WD patients have a significantly higher incidence of cholecystitis and a poorer prognosis. The hepatic immune cell landscape using single-cell RNA sequencing showed that the tissue immune microenvironment is altered in WD, mainly a major change in the constitution and function of the innate immune system. Exhaustion of natural killer (NK) cells is the fundamental factor, supported by the upregulated expression of inhibitory receptors and the downregulated expression of cytotoxic molecules, which was verified in clinical samples. Further bioinformatic analysis confirmed a positive correlation between NK cell exhaustion and poor prognosis in cholecystitis and other inflammatory diseases. The study demonstrated dysfunction of liver immune cells triggered by specific metabolic abnormalities in WD, with a focus on the correlation between NK cell exhaustion and poor healing of cholecystitis, providing new insights into the improvement of inflammatory diseases by assessing immune cell function.
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Affiliation(s)
- Yong Jin
- Cancer Research Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiChina
| | - Jiayu Xing
- Cancer Research Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiChina
| | - Chenyu Dai
- Department of Cadre Cardiology, The First Affiliated Hospital of Anhui University of Chinese MedicineHefeiChina
| | - Lei Jin
- Department of General Surgery, The First Affiliated Hospital of Anhui University of Chinese MedicineHefeiChina
- Institute of Chinese Medicine Surgery, Anhui Academy of Chinese MedicineHefeiChina
| | - Wanying Zhang
- Cancer Research Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiChina
| | - Qianqian Tao
- Department of General Surgery, The First Affiliated Hospital of Anhui University of Chinese MedicineHefeiChina
- Institute of Chinese Medicine Surgery, Anhui Academy of Chinese MedicineHefeiChina
| | - Mei Hou
- Cancer Research Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiChina
| | - Ziyi Li
- Department of General Surgery, The First Affiliated Hospital of Anhui University of Chinese MedicineHefeiChina
- Institute of Chinese Medicine Surgery, Anhui Academy of Chinese MedicineHefeiChina
| | - Wen Yang
- Cancer Research Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiChina
- International Co-operation Laboratory on Signal Transduction, Eastern Hepatobiliary Surgery Hospital, Second Military Medical UniversityShanghaiChina
- National Center for Liver Cancer, Second Military Medical UniversityShanghaiChina
| | - Qiyu Feng
- Cancer Research Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiChina
| | - Hongyang Wang
- Cancer Research Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiChina
- International Co-operation Laboratory on Signal Transduction, Eastern Hepatobiliary Surgery Hospital, Second Military Medical UniversityShanghaiChina
- National Center for Liver Cancer, Second Military Medical UniversityShanghaiChina
| | - Qingsheng Yu
- Department of Cadre Cardiology, The First Affiliated Hospital of Anhui University of Chinese MedicineHefeiChina
- Department of General Surgery, The First Affiliated Hospital of Anhui University of Chinese MedicineHefeiChina
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Morgan MA, DePietro DM, Whorms DS, Pantel AR, Ganeshan D, Goldman IA, Yang J, Khot R. Acalculous cholecystitis- an imaging and therapeutic update. Abdom Radiol (NY) 2024:10.1007/s00261-024-04691-0. [PMID: 39680125 DOI: 10.1007/s00261-024-04691-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 11/02/2024] [Accepted: 11/07/2024] [Indexed: 12/17/2024]
Abstract
In this review, we highlight current understanding of the pathogenesis of acalculous cholecystitis, as well as its key imaging and clinical features. We also review what happens after a diagnosis and outline current interventional methods.
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Affiliation(s)
| | | | - Debra S Whorms
- University of Pennsylvania Health System, Philadelphia, USA
| | | | | | | | - Julie Yang
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Rachita Khot
- University of Virginia Health, Charlottesville, USA
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Eustace M, Strey G, Kidd TJ, McNamara JF. Probable zoonotic pulmonary prosthetic valve infective endocarditis and acalculous cholecystitis caused by Streptococcus equi subspecies zooepidemicus. BMJ Case Rep 2024; 17:e262383. [PMID: 39496336 PMCID: PMC11557452 DOI: 10.1136/bcr-2024-262383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 09/19/2024] [Indexed: 11/06/2024] Open
Abstract
Prosthetic pulmonary valve endocarditis is a rare but serious infective complication following correction of tetralogy of Fallot (ToF). We describe a probable zoonotic case of Streptococcus equi subspecies zooepidemicus prosthetic pulmonary valve infective endocarditis in a young woman with corrected ToF with regular exposure to horses. The case was further complicated by acalculous cholecystitis, which was the initial presenting syndrome, requiring laparoscopic cholecystectomy. Microbiological analysis of blood cultures yielded growth of S. equi with whole genome sequencing confirming the subspecies identification of zooepidemicus The patient underwent successful combined medical and surgical management incorporating a 6-week course of intravenous antibiotics and a re-do homograft pulmonary valve replacement followed by prolonged oral antibiotic therapy. Clinicians should be mindful of the increased risk of endocarditis in adult congenital heart disease and relevant bacteraemia detection should prompt thorough valvular assessment.
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Affiliation(s)
- Matthew Eustace
- Pathology Queensland—Central Microbiology Laboratory, Queensland Health, Brisbane, Queensland, Australia
- Royal Brisbane Clinical Unit, University of Queensland School of Medicine, Herston, Queensland, Australia
| | - Gabriela Strey
- General Medicine, Queensland Health, Hervey Bay, Queensland, Australia
| | - Timothy J Kidd
- Pathology Queensland—Central Microbiology Laboratory, Queensland Health, Brisbane, Queensland, Australia
| | - John F McNamara
- Infectious Diseases Unit, The Prince Charles Hospital, Chermside, Queensland, Australia
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Stead WW, Lewis A, Giuse NB, Williams AM, Biaggioni I, Bastarache L. Disentangling the phenotypic patterns of hypertension and chronic hypotension. J Biomed Inform 2024; 159:104743. [PMID: 39486471 PMCID: PMC11722018 DOI: 10.1016/j.jbi.2024.104743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 10/03/2024] [Accepted: 10/29/2024] [Indexed: 11/04/2024]
Abstract
OBJECTIVE 2017 blood pressure (BP) categories focus on cardiac risk. We hypothesize that studying the balance between mechanisms that increase or decrease BP across the medical phenome will lead to new insights. We devised a classifier that uses BP measures to assign individuals to mutually exclusive categories centered in the upper (Htn), lower (Hotn) and middle (Naf) zones of the BP spectrum; and examined the epidemiologic and phenotypic patterns of these BP-categories. METHODS We classified a cohort of 832,560 deidentified electronic health records by BP-category; compared the frequency of BP-categories and four subtypes of Htn and Hotn by sex and age-decade; visualized the distributions of systolic, diastolic, mean arterial and pulse pressures stratified by BP-category; and ran Phenome-wide Association Studies (PheWAS) for Htn and Hotn. We paired knowledgebases for hypertension and hypotension and computed aggregate knowledgebase status (KB-status) indicating known associations. We assessed alignment of PheWAS results with KB-status for phecodes in the knowledgebase, and paired PheWAS correlations with KB-status to surface phenotypic patterns. RESULTS BP-categories represent distinct distributions within the multimodal distributions of systolic and diastolic pressure. They are centered in the upper, lower, and middle zones of mean arterial pressure and provide a different signal than pulse pressure. For phecodes in the knowledgebase, 85% of positive correlations align with KB-status. Phenotypic patterns for Htn and Hotn overlap for several phecodes and are separate for others. Our analysis suggests five candidates for hypothesis testing research, two where the prevalence of the association with Htn or Hotn may be under appreciated, three where mechanisms that increase and decrease blood pressure may be affecting one another's expression. CONCLUSION PairedPheWAS methods may open a phenome-wide path to disentangling hypertension and chronic hypotension. Our classifier provides a starting point for assigning individuals to BP-categories representing the upper, lower, and middle zones of the BP spectrum. 4.7 % of individuals matching 2017 BP categories for normal, elevated BP or isolated hypertension, have diastolic pressure < 60. Research is needed to fine-tune the classifier, provide external validation, evaluate the clinical significance of diastolic pressure < 60, and test the candidate hypotheses.
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Affiliation(s)
- William W Stead
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Adam Lewis
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nunzia B Giuse
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Knowledge Management, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Annette M Williams
- Center for Knowledge Management, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Italo Biaggioni
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lisa Bastarache
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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Koushesh P, Ayaz T, Tullius T. Percutaneous Cholecystostomy: Procedural Guidance and Future Directions for Clinical Management. Semin Intervent Radiol 2024; 41:460-465. [PMID: 39664225 PMCID: PMC11631362 DOI: 10.1055/s-0044-1791724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2024]
Abstract
Percutaneous cholecystostomy (PC) is a recognized treatment option for the management of acute cholecystitis and is an integral component of the treatment algorithm in the 2018 Tokyo Guidelines. The utilization of PC has significantly increased over the past 30 years, particularly in the setting of critically ill patients and those with extensive comorbidities who are poor surgical candidates. The indications, complications, patient selection considerations, and technical complexities of the procedure will be discussed. Postprocedural drain management and the potential for shortened indwelling time are reviewed.
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Affiliation(s)
- Pouria Koushesh
- Department of Radiology, TTUHSC El Paso PLFSOM, El Paso, Texas
| | - Talha Ayaz
- Department of Radiology, University of Texas Medical Branch, Galveston, Texas
| | - Thomas Tullius
- Department of Radiology, University Medical Center El Paso, TTUHSC El Paso PLFSOM, El Paso, Texas
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10
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Neitzel E, Laskus J, Mueller PR, Kambadakone A, Srinivas-Rao S, vanSonnenberg E. Part 1: Current Concepts in Radiologic Imaging and Intervention in Acute Cholecystitis. J Intensive Care Med 2024:8850666241259421. [PMID: 38839258 DOI: 10.1177/08850666241259421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Acute calculous cholecystitis and acute acalculous cholecystitis are encountered commonly among critically ill, often elderly, patients. Multidisciplinary management of these conditions is essential, with intensivists, surgeons, diagnostic radiologists, interventional radiologists, infectious disease physicians, gastroenterologists, and endoscopists able to contribute to patient care. In this article intended predominantly for intensivists, we will review the imaging findings and radiologic treatment of critically ill patients with acute calculous cholecystitis and acute acalculous cholecystitis.
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Affiliation(s)
- Easton Neitzel
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Julia Laskus
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Peter R Mueller
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shravya Srinivas-Rao
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric vanSonnenberg
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
- Department of Radiology and Department of Student Affairs, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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11
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Lai YT, Kalimuddin S, Ng HJH, Tay GCA. Acute acalculous cholecystitis in dengue fever: a case series. Singapore Med J 2024; 65:364-367. [PMID: 34688232 PMCID: PMC11232707 DOI: 10.11622/smedj.2021168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 08/19/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Yi Ting Lai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shirin Kalimuddin
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Hannah Jia Hui Ng
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Gerald Ci An Tay
- Department of Head and Neck Surgery, Singapore General Hospital, Singapore
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12
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Konagaya K, Kume N, Ogino H. Duodenal Ulcer Perforation Causing Acute Cholecystitis. Cureus 2024; 16:e61293. [PMID: 38813075 PMCID: PMC11134304 DOI: 10.7759/cureus.61293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 05/31/2024] Open
Abstract
Acute cholecystitis is an inflammatory condition of the gallbladder, characterized by infection, ulceration, and neutrophilic infiltration of the gallbladder wall. Approximately 90% of cases are caused by gallstones. In contrast, acalculous cholecystitis is defined as the inflammation of the gallbladder in the absence of gallstones during diagnosis. The causes of acalculous cholecystitis include impaired blood flow to the gallbladder, chemical injury, bacterial or parasitic infections, and collagen vascular diseases. However, in this case, it was caused by an extremely rare condition: a duodenal ulcer penetration. Physical examination, blood tests, and ultrasound suggested a diagnosis of acute cholecystitis. However, contrast-enhanced CT showed no gallstones and revealed a partial mucosal defect in the first portion of the anterior duodenum. There was also wall thickening and increased density of the surrounding fat tissue, particularly around the gallbladder wall adjacent to the first portion of the anterior duodenum. Based on these findings, secondary cholecystitis due to perforation of a duodenal ulcer was diagnosed, and laparoscopic cholecystectomy with omental patching was performed. Although rare, a duodenal ulcer should be considered as a cause of acalculous cholecystitis.
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Affiliation(s)
| | - Nao Kume
- Vascular Surgery, Narita Tomisato Tokushukai Hospital, Chiba, JPN
| | - Hidemitsu Ogino
- Vascular Surgery, Narita Tomisato Tokushukai Hospital, Chiba, JPN
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Daskalov AT. Antegrade Aorto-Mesenteric Bypass Using a Prefabricated Bovine Pericardium Tube Graft for the Treatment of Chronic Mesenteric Ischemia Complicated With Intestinal Necrosis and Biliary Peritonitis. Cureus 2024; 16:e57530. [PMID: 38707110 PMCID: PMC11067987 DOI: 10.7759/cureus.57530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
Chronic mesenteric ischemia (CMI) is a vascular disorder primarily caused by atherosclerosis, resulting in intestinal ischemia. While endovascular treatment has become the primary modality for most patients, open mesenteric revascularization remains crucial for complex cases. We present a case of CMI in a patient with critical ischemia, leading to small bowel necrosis, where the endovascular recanalization failed and a surgical approach was needed. A supraceliac antegrade aortomesenteric bypass was performed, and successful revascularization of intestinal circulation was achieved. A novel prefabricated bovine pericardium tube was used as a graft, and the bypass was placed behind the pancreas to ensure maximal isolation from the contaminated abdominal cavity. Despite the intestinal revascularization, in the early postoperative period, the overall condition of the patient worsened with obvious signs of peritonitis. The second look operation revealed a ruptured gallbladder with severe biliary peritonitis, likely caused by the preceding splanchnic ischemia. A cholecystectomy, lavage, and drainage were performed. No further intestinal necrosis was observed, and the bowel passage was restored with latero-lateral jejuno-lejunostomy. The follow-up of the patient showed no signs of graft infection. Despite the complications, the patient's postoperative period was stable, and he was discharged on day sixteen. Regular follow-ups confirmed an excellent patency of the bypass.
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Thomaidou E, Karlafti E, Didagelos M, Megari K, Argiriadou E, Akinosoglou K, Paramythiotis D, Savopoulos C. Acalculous Cholecystitis in COVID-19 Patients: A Narrative Review. Viruses 2024; 16:455. [PMID: 38543820 PMCID: PMC10976146 DOI: 10.3390/v16030455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 05/23/2024] Open
Abstract
Acute acalculous cholecystitis (AAC) represents cholecystitis without gallstones, occurring in approximately 5-10% of all cases of acute cholecystitis in adults. Several risk factors have been recognized, while infectious diseases can be a cause of cholecystitis in otherwise healthy people. Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has spread worldwide, leading to an unprecedented pandemic. The virus enters cells through the binding of the spike protein to angiotensin-converting enzyme 2 (ACE2) receptors expressed in many human tissues, including the epithelial cells of the gastrointestinal (GI) tract, and this explains the symptoms emanating from the digestive system. Acute cholecystitis has been reported in patients with COVID-19. The purpose of this review is to provide a detailed analysis of the current literature on the pathogenesis, diagnosis, management, and outcomes of AAC in patients with COVID-19.
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Affiliation(s)
- Evanthia Thomaidou
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.T.); (M.D.); (E.A.)
| | - Eleni Karlafti
- Emergency Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
- First Propaedeutic Internal Medicine Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Matthaios Didagelos
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.T.); (M.D.); (E.A.)
- 1st Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Kalliopi Megari
- CITY College, University of York Europe Campus, 54626 Thessaloniki, Greece;
| | - Eleni Argiriadou
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.T.); (M.D.); (E.A.)
| | - Karolina Akinosoglou
- Department of Medicine, University General Hospital of Patras, 26504 Rio, Greece;
| | - Daniel Paramythiotis
- First Propaedeutic Department of Surgery, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Christos Savopoulos
- First Propaedeutic Internal Medicine Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
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15
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Thomaidou E, Karlafti E, Didagelos M, Megari K, Argiriadou E, Akinosoglou K, Paramythiotis D, Savopoulos C. Acalculous Cholecystitis in COVID-19 Patients: A Narrative Review. Viruses 2024; 16:455. [DOI: https:/doi.org/10.3390/v16030455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2025] Open
Abstract
Acute acalculous cholecystitis (AAC) represents cholecystitis without gallstones, occurring in approximately 5–10% of all cases of acute cholecystitis in adults. Several risk factors have been recognized, while infectious diseases can be a cause of cholecystitis in otherwise healthy people. Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has spread worldwide, leading to an unprecedented pandemic. The virus enters cells through the binding of the spike protein to angiotensin-converting enzyme 2 (ACE2) receptors expressed in many human tissues, including the epithelial cells of the gastrointestinal (GI) tract, and this explains the symptoms emanating from the digestive system. Acute cholecystitis has been reported in patients with COVID-19. The purpose of this review is to provide a detailed analysis of the current literature on the pathogenesis, diagnosis, management, and outcomes of AAC in patients with COVID-19.
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Affiliation(s)
- Evanthia Thomaidou
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Eleni Karlafti
- Emergency Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- First Propaedeutic Internal Medicine Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Matthaios Didagelos
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- 1st Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Kalliopi Megari
- CITY College, University of York Europe Campus, 54626 Thessaloniki, Greece
| | - Eleni Argiriadou
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Karolina Akinosoglou
- Department of Medicine, University General Hospital of Patras, 26504 Rio, Greece
| | - Daniel Paramythiotis
- First Propaedeutic Department of Surgery, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Christos Savopoulos
- First Propaedeutic Internal Medicine Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
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16
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Weingrow D. Implications and Limitations of Point-of-Care Ultrasound in Diagnosing Acute Cholecystitis. Ann Emerg Med 2024; 83:247-249. [PMID: 38388078 DOI: 10.1016/j.annemergmed.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/19/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024]
Affiliation(s)
- Daniel Weingrow
- Department of Emergency Medicine, University of California Los Angeles, Los Angeles, CA.
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17
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Decker C, Liu D. Non-Traumatic Hepatobiliary Emergencies. Surg Clin North Am 2023; 103:1171-1190. [PMID: 37838462 DOI: 10.1016/j.suc.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Hepatobiliary emergencies typically present with a constellation of different symptoms including abdominal pain, fevers, nausea, vomiting, jaundice, coagulopathy, and in some instances, encephalopathy. The differential can be broad and may include infectious, inflammatory, and even iatrogenic etiologies. Workup with appropriate lab and imaging studies can help discern between different pathologies and thus guide their management. Interventions can range broadly from conservative management with medical therapy to endoscopic options or surgery. This article explores the diagnostic workup and evaluation as well as the current therapeutic interventions for a variety of these nontraumatic hepatobiliary emergencies based on the most current literature.
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Affiliation(s)
- Christopher Decker
- Temple University Hospital Department of Surgery, 3401 N. Broad St., Philadelphia, PA 19104, USA.
| | - Dorothy Liu
- Temple University Hospital Department of Surgery, 3401 N. Broad St., Philadelphia, PA 19104, USA
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18
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Huang SS, Lin KW, Liu KL, Wu YM, Lien WC, Wang HP. Diagnostic performance of ultrasound in acute cholecystitis: a systematic review and meta-analysis. World J Emerg Surg 2023; 18:54. [PMID: 38037062 PMCID: PMC10687940 DOI: 10.1186/s13017-023-00524-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/25/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND An updated overview of ultrasound (US) for diagnosis of acute cholecystitis (AC) remains lacking. This systematic review was conducted to evaluate the diagnostic performance of US for AC. METHODS A systematic review was conducted following PRISMA guidelines. We meticulously screened articles from MEDLINE, Embase, and the Cochrane Library, spanning from inception to August 2023. We employed the search strategy combining the keywords "bedside US", "emergency US" or "point-of-care US" with "AC". Two reviewers independently screened the titles and abstracts of the retrieved articles to identify suitable studies. The inclusion criteria encompassed articles investigating the diagnostic performance of US for AC. Data regarding diagnostic performance, sonographers, and sonographic findings including the presence of gallstone, gallbladder (GB) wall thickness, peri-GB fluid, or sonographic Murphy sign were extracted, and a meta-analysis was executed. Case reports, editorials, and review articles were excluded, as well as studies focused on acalculous cholecystitis. The study quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. RESULTS Forty studies with 8,652 patients were included. The majority of studies had a low risk of bias and applicability concerns. US had a pooled sensitivity of 71% (95% CI, 69-72%), a specificity of 85% (95% CI, 84-86%), and an accuracy of 0.83 (95% CI, 0.82-0.83) for the diagnosis of AC. The pooled sensitivity and specificity were 71% (95% CI, 67-74%) and 92% (95% CI, 90-93%) performed by emergency physicians (EPs), 79% (95% CI, 71-85%) and 76% (95% CI, 69-81%) performed by surgeons, and 68% (95% CI 66-71%) and 87% (95% CI, 86-88%) performed by radiologists, respectively. There were no statistically significant differences among the three groups. CONCLUSION US is a good imaging modality for the diagnosis of AC. EP-performed US has a similar diagnostic performance to radiologist-performed US. Further investigations would be needed to investigate the impact of US on expediting the management process and improving patient-centered outcomes.
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Affiliation(s)
- Sih-Shiang Huang
- Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, No.7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Kai-Wei Lin
- Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, No.7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Kao-Lang Liu
- Department of Medical Imaging, National Taiwan University Cancer Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medical Imaging, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yao-Ming Wu
- Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, No.7, Chung-Shan South Road, Taipei, 100, Taiwan.
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Hsiu-Po Wang
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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19
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AbiMansour JP, Law RJ, Storm AC, Chandrasekhara V. Tips and tricks for endoscopic transpapillary gallbladder drainage. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:474-477. [PMID: 38026704 PMCID: PMC10665532 DOI: 10.1016/j.vgie.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Background and Aims Percutaneous gallbladder drainage has traditionally been the reference standard treatment for cholecystitis in patients deemed unfit for surgery. Endoscopic transpapillary gallbladder drainage has emerged as a reliable alternative that offers an internal, incisionless option in nonsurgical patients. The aim of this study was to describe techniques for successful selective cystic duct cannulation and gallbladder drainage during ERCP. Methods A series of endoscopic transpapillary gallbladder procedures is shown, including endoscopic and fluoroscopic video and images. Each case highlights best practices, devices, and techniques to aid with successful completion of challenging cases. Results Standard cystic duct cannulation and gallbladder access is described using a standard catheter and a 0.035-inch angled guidewire. Challenges to selective cystic duct cannulation are overcome using various approaches, including using a rotatable catheter system, downsizing to a smaller guidewire, occluding the proximal common hepatic duct with an occlusion balloon, and directly intubating the cystic duct using peroral cholangioscopy. Dilation of the cystic duct is performed using standard devices designed for biliary intervention, but smaller, percutaneous angioplasty balloons are used for small ducts and severe strictures. After dilation, a plastic, double-pigtail stent is deployed across the papilla, and access is reobtained in a similar fashion to place a second, parallel stent. To eliminate the need to re-access the gallbladder after initial stent deployment, a cytology brush catheter is repurposed to obtain dual-wire access within the gallbladder before initial stent deployment. Conclusions When the fundamentals of ERCP and the techniques described here are used, endoscopic transpapillary gallbladder drainage can be performed safely and effectively to treat cholecystitis in patients who are not surgical candidates.
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Affiliation(s)
- Jad P AbiMansour
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Ryan J Law
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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20
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Arkoudis NA, Moschovaki-Zeiger O, Reppas L, Grigoriadis S, Alexopoulou E, Brountzos E, Kelekis N, Spiliopoulos S. Percutaneous cholecystostomy: techniques and applications. Abdom Radiol (NY) 2023; 48:3229-3242. [PMID: 37338588 DOI: 10.1007/s00261-023-03982-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
Acute cholecystitis (AC) is a critical condition requiring immediate medical attention and treatment and is one of the most frequently encountered acute abdomen emergencies in surgical practice, requiring hospitalization. Laparoscopic cholecystectomy is considered the favored treatment for patients with AC who are fit for surgery. However, in high-risk patients considered poor surgical candidates, percutaneous cholecystostomy (PC) has been suggested and employed as a safe and reliable alternative option. PC is a minimally invasive, nonsurgical, image-guided intervention that drains and decompresses the gallbladder, thereby preventing its perforation and sepsis. It can act as a bridge to surgery, but it may also serve as a definitive treatment for some patients. The goal of this review is to familiarize physicians with PC and, more importantly, its applications and techniques, pre- and post-procedural considerations, and adverse events.
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Affiliation(s)
- Nikolaos-Achilleas Arkoudis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece.
| | - Ornella Moschovaki-Zeiger
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
- Interventional Radiology Department, Bioclinic General Hospital of Athens, Marinou Geroulanou 15, 115 24, Athens, Greece
| | - Stavros Grigoriadis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Efthymia Alexopoulou
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
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21
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Fiel MI, Schiano TD. Systemic Disease and the Liver Part 2: Pregnancy-Related Liver Injury, Sepsis/Critical Illness, Hypoxia, Psoriasis, Scleroderma/Sjogren's Syndrome, Sarcoidosis, Common Variable Immune Deficiency, Cystic Fibrosis, Inflammatory Bowel Disease, and Hematologic Disorders. Surg Pathol Clin 2023; 16:485-498. [PMID: 37536884 DOI: 10.1016/j.path.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
The liver is involved in many multisystem diseases and commonly may manifest with abnormal liver chemistry tests. The liver test perturbations may be multifactorial in nature, however, as patients are receiving many different medications and can also have intrinsic liver disease that may be exacerbated by the systemic disorder. Some disorders have typical histologic findings that can be diagnosed on liver biopsy, whereas others will show a more nonspecific histology. Clinicians should be aware of these conditions so as to consider the performance of a liver biopsy at the most opportune time and setting to help establish the diagnosis of acute or chronic liver disease.
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Affiliation(s)
- Maria Isabel Fiel
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, USA.
| | - Thomas D Schiano
- Division of Liver Diseases, Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place-Box 1104, New York, NY 10029, USA
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22
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Nve E, Badia JM, Amillo-Zaragüeta M, Juvany M, Mourelo-Fariña M, Jorba R. Early Management of Severe Biliary Infection in the Era of the Tokyo Guidelines. J Clin Med 2023; 12:4711. [PMID: 37510826 PMCID: PMC10380792 DOI: 10.3390/jcm12144711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/28/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Sepsis of biliary origin is increasing worldwide and has become one of the leading causes of emergency department admissions. The presence of multi-resistant bacteria (MRB) is increasing, and mortality rates may reach 20%. This review focuses on the changes induced by the Tokyo guidelines and new concepts related to the early treatment of severe biliary disease. If cholecystitis or cholangitis is suspected, ultrasound is the imaging test of choice. Appropriate empirical antibiotic treatment should be initiated promptly, and selection should be performed while bearing in mind the severity and risk factors for MRB. In acute cholecystitis, laparoscopic cholecystectomy is the main therapeutic intervention. In patients not suitable for surgery, percutaneous cholecystostomy is a valid alternative for controlling the infection. Treatment of severe acute cholangitis is based on endoscopic or transhepatic bile duct drainage and antibiotic therapy. Endoscopic ultrasound and other new endoscopic techniques have been added to the arsenal as novel alternatives in high-risk patients. However, biliary infections remain serious conditions that can lead to sepsis and death. The introduction of internationally accepted guidelines, based on clinical presentation, laboratory tests, and imaging, provides a framework for their rapid diagnosis and treatment. Prompt assessment of patient severity, timely initiation of antimicrobials, and early control of the source of infection are essential to reduce morbidity and mortality rates.
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Affiliation(s)
- Esther Nve
- Department of Surgery, Hospital Universitari Mútua de Terrassa, 08221 Barcelona, Spain;
- School of Medicine, Universitat Rovira i Virgili, 43003 Tarragona, Spain;
| | - Josep M. Badia
- Department of Surgery, Hospital General Granollers, School of Medicine, Universitat Internacional de Catalunya, Av Francesc Ribas 1, 08402 Granollers, Spain; (M.A.-Z.); (M.J.)
| | - Mireia Amillo-Zaragüeta
- Department of Surgery, Hospital General Granollers, School of Medicine, Universitat Internacional de Catalunya, Av Francesc Ribas 1, 08402 Granollers, Spain; (M.A.-Z.); (M.J.)
| | - Montserrat Juvany
- Department of Surgery, Hospital General Granollers, School of Medicine, Universitat Internacional de Catalunya, Av Francesc Ribas 1, 08402 Granollers, Spain; (M.A.-Z.); (M.J.)
| | - Mónica Mourelo-Fariña
- Intensive Care Unit, Complexo Hospitalario Universitario A Coruña, 15006 A Coruña, Spain;
| | - Rosa Jorba
- School of Medicine, Universitat Rovira i Virgili, 43003 Tarragona, Spain;
- Department of Surgery, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
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23
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Cao X, Jiang W, Shi L, Wang Y, Chen J, Huang W, Zhang S. Acalculous cholecystitis is a common extrahepatic manifestation of hepatitis E and suggests a more serious condition. Virol J 2023; 20:77. [PMID: 37095526 PMCID: PMC10124029 DOI: 10.1186/s12985-023-02045-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/18/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND This study aimed to understand the incidence and clinical significance of acalculous cholecystitis in patients with acute hepatitis E (HE). PATIENTS AND METHODS A single center enrolled 114 patients with acute HE. All patients underwent imaging of the gallbladder, and patients with gallstones and cholecystectomy were excluded. RESULTS Acalculous cholecystitis was found in 66 patients (57.89%) with acute HE. The incidence in males was 63.95%, which was significantly higher than in females (39.29%) (P = 0.022). The mean length of hospital stay and the incidence of spontaneous peritonitis in patients with cholecystitis (20.12 ± 9.43 days and 9.09%, respectively) were significantly higher than those in patients without cholecystitis (12.98 ± 7.26 days and 0%, respectively) (P < 0.001 and P = 0.032). Albumin, total bile acid, bilirubin, cholinesterase, and prothrombin activity in patients with cholecystitis were significantly inferior to those in patients without cholecystitis (P < 0.001, P < 0.001, P < 0.001, P < 0.001 and P = 0.003, respectively). After correction by multivariate analysis, albumin and total bile acid were found to be closely related to acalculous cholecystitis in HE. CONCLUSION Acalculous cholecystitis is very common in patients with acute HE, and may serve as a predictor of increased peritonitis, synthetic decompensation, and longer hospital stay.
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Affiliation(s)
- Xuemei Cao
- Chongqing Key Laboratory of Infectious Diseases and Parasitic Diseases, Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Wei Jiang
- Chongqing Key Laboratory of Infectious Diseases and Parasitic Diseases, Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Lingfeng Shi
- Chongqing Key Laboratory of Infectious Diseases and Parasitic Diseases, Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
- Department of Infectious Diseases, Youyang Hospital, A Branch of The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanping Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Chen
- Chongqing Key Laboratory of Infectious Diseases and Parasitic Diseases, Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Wenxiang Huang
- Chongqing Key Laboratory of Infectious Diseases and Parasitic Diseases, Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Shujun Zhang
- Chongqing Key Laboratory of Infectious Diseases and Parasitic Diseases, Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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Salajegheh F, Shafieipour S, Najminejad Z, Pourzand P, Nakhaie M, Jahangiri S, Sarmadian R, Gilani A, Rukerd MRZ. HAV-induced acalculous cholecystitis: A case report and literature review. Clin Case Rep 2023; 11:e7254. [PMID: 37113636 PMCID: PMC10127462 DOI: 10.1002/ccr3.7254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/02/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Hepatitis A virus (HAV) has some life-threatening extrahepatic complications, such as acute acalculous cholecystitis (AAC). We present HAV-induced AAC in a young female, based on clinical, laboratory, and imaging findings, and conduct a literature review. The patient became irritable, which progressed to lethargy, as well as a significant decline in liver function, indicating acute liver failure (ALF). She was immediately managed in the intensive care unit with close airway and hemodynamic monitoring after being diagnosed with ALF (ICU). The patient's condition was improving, despite only close monitoring and supportive treatment with ursodeoxycholic acid (UDCA) and N-acetyl cysteine (NAC).
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Affiliation(s)
- Faranak Salajegheh
- Clinical Research Development Unit, School of MedicineAfzalipour Hospital, Kerman University of Medical SciencesKermanIran
| | - Sara Shafieipour
- Physiology Research Center, Institute of NeuropharmacologyKerman University of Medical SciencesKermanIran
| | - Zohre Najminejad
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology SciencesKerman University of Medical Sciences KermanKermanIran
| | - Pouria Pourzand
- School of MedicineZahedan University of Medical SciencesZahedanIran
| | - Mohsen Nakhaie
- Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology SciencesKerman University of Medical SciencesKermanIran
| | - Samaneh Jahangiri
- Clinical Research Development Unit, School of MedicineAfzalipour Hospital, Kerman University of Medical SciencesKermanIran
| | - Roham Sarmadian
- Infectious disease research centerArak University of Medical SciencesArakIran
| | - Abolfazl Gilani
- Department of pediatric surgeryTehran university of Medical SciencesTehranIran
| | - Mohammad Rezaei Zadeh Rukerd
- Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology SciencesKerman University of Medical SciencesKermanIran
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Gluhovschi C, Gadalean F, Velciov S, Petrica L, Duta C, Botoca M, Cipu D. Acute Acalculous Cholecystitis Associated with Abscesses-An Unknown Dual Pathology. Biomedicines 2023; 11:biomedicines11020632. [PMID: 36831168 PMCID: PMC9953605 DOI: 10.3390/biomedicines11020632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
(1) Introduction and Aims: Little is known about the relationship between renal pathology and gallbladder pathology, although the two organs (the gallbladder and the right kidney) are in close proximity to one another. If a renal abscess disseminates, the gallbladder would be one of the secondary organs involved. As the bile provides a favorable environment for the development of pathogenic germs, it allows for the development of acute cholecystitis, even if calculi are absent, thus resulting in the development of acute acalculous cholecystitis. The aim of our study was to analyze the association between acute acalculous cholecystitis (AAC) and renal abscesses. (2) Methods: A department-wide retrospective cohort observational study including 67 patients with renal abscesses, with a mean age of 34.5+/-16.21 years and with five males and 62 females, was conducted. All of the patients were examined by an abdominal ultrasound. The lab tests included CBC with differential liver enzymes and serum bilirubin (in order to assess alterations in the liver function which can be associated with AAC) and serum creatinine (in order to assess the renal function). Blood culture and urine culture tests were also performed. (3) Results: Of the 67 patients with renal abscesses, eight (11.94%) were associated with acute cholecystitis: four cases (5.97%) of acalculous cholecystitis and four cases (5.97%) of calculous cholecystitis, two of which presented biliary sludge (acute micro-calculous cholecystitis). All four cases of acute acalculous cholecystitis presented with sepsis, and there was one case of septic shock at onset. We did not observe an impairment in renal function in the patients presenting with acute acalculous cholecystitis, and hepatic impairment was inconstant and moderate. All of the cases had a favorable outcome after a prompt initiation of intensive antibiotic therapy; both the renal abscess and the acute acalculous cholecystitis receded without further complications. (4) Conclusions: The association of acute acalculous cholecystitis with renal abscesses could be related to the possibility of germ dissemination from the infectious focus. In the case of a renal abscess, careful clinical, lab, and imaging exams of the gallbladder are recommended in order to ensure early therapeutic intervention in the event of an association with acute acalculous cholecystitis.
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Affiliation(s)
- Cristina Gluhovschi
- Department of Internal Medicine II, Division of Nephrology, “Victor Babeș” University of Medicine and Pharmacy, County Emergency Hospital Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- Correspondence: or
| | - Florica Gadalean
- Department of Internal Medicine II, Division of Nephrology, “Victor Babeș” University of Medicine and Pharmacy, County Emergency Hospital Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Silvia Velciov
- Department of Internal Medicine II, Division of Nephrology, “Victor Babeș” University of Medicine and Pharmacy, County Emergency Hospital Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Ligia Petrica
- Department of Internal Medicine II, Division of Nephrology, “Victor Babeș” University of Medicine and Pharmacy, County Emergency Hospital Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Ciprian Duta
- Department X Surgery II, Division of Surgery II, “Victor Babeș” University of Medicine and Pharmacy, County Emergency Hospital Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Mircea Botoca
- Department XV Orthopedics-Traumatology, Urology, Radiology and Medical Imaging, Division of Urology, “Victor Babeș” University of Medicine and Pharmacy, County Emergency Hospital Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Daniela Cipu
- Department XV Orthopedics-Traumatology, Urology, Radiology and Medical Imaging, Division of Radiology and Medical Imaging, “Victor Babeș” University of Medicine and Pharmacy, County Emergency Hospital Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
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Yao P, Chang Z, Li B, Wang C, Liu Z. Clinical characteristics and prognosis of patients with healthcare-associated cholecystitis receiving percutaneous cholecystostomy. LANGENBECK'S ARCHIVES OF SURGERY 2023; 408:20. [PMID: 36633712 DOI: 10.1007/s00423-023-02757-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 10/19/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE Acute cholecystitis occurring outside the hospital setting is categorized as community-acquired cholecystitis (CAC). In contrast, it would be classified as a healthcare-associated cholecystitis (HAC) when it is associated with healthcare risk factors. This study aimed to compare the clinical characteristics of HAC to those of CAC and analyze their difference in prognosis after percutaneous cholecystostomy (PC). METHODS A retrospective study was conducted for patients with acute cholecystitis who underwent PC between January 1, 2017, and June 30, 2020, in our hospital. Patients with HAC and CAC were compared in terms of demographics, laboratory tests, isolated pathogens, treatment response after PC, mortality, complications, and subsequent management. RESULTS A total of 247 patients with a mean age of 68 years were enrolled, among whom 131 patients (53.0%) were male. Twenty patients (8.1%) had HAC, and 227 patients (91.9%) had CAC. Patients with HAC were more likely to present with the following: fever (65.0% vs 35.7%; p = 0.010), acalculous cholecystitis (50.0% vs 20.3%; p = 0.002), and a history of malignancy (50.0% vs 15.4%; p < 0.001), poorer clinical responses to PC treatment (75.0% vs 93.0%; p = 0.006), longer length of stay (14.15 days vs 7.62 days; p < 0.001), and higher all-cause mortality (30.0% vs 9.7%; p = 0.006). In addition, a relatively small number of patients with HAC underwent cholecystectomy in subsequent management (35.0% vs 69.2%; p = 0.002). CONCLUSIONS In conclusion, compared to patients with CAC, those with HAC had more atypical symptoms, poorer clinical response to PC, longer hospital stay, and higher all-cause mortality, which makes the acceptability of PC treatment questionable.
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Affiliation(s)
- Peng Yao
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China
| | - Zhihui Chang
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China
| | - Beibei Li
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China
| | - Chuanzhuo Wang
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China.
| | - Zhaoyu Liu
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China
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Öcal S, Eren Durmuş M, Yalçın İŞ, Alparslan AŞ, Çekin AH, Durmuş E. ACUTE ACALCULOUS CHOLECYSTITIS TRIGGERED BY AN ACUTE FLARE-UP IN VIRAL HEPATITIS B INFECTION: A CASE REPORT. Gastroenterol Nurs 2023; 46:67-70. [PMID: 36706144 DOI: 10.1097/sga.0000000000000714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 07/08/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
- Serkan Öcal
- Serkan Öcal, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Merve Eren Durmusş, MD, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- İbrahim Şenel Yalçn, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ahmet Şükrü Alparslan, is at Department of Radiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ayhan Hilmi Çekin, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Emin Durmuş, is at Department of Radiology, Antalya Atatürk Public Hospital, Antalya, Turkey
| | - Merve Eren Durmuş
- Serkan Öcal, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Merve Eren Durmusş, MD, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- İbrahim Şenel Yalçn, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ahmet Şükrü Alparslan, is at Department of Radiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ayhan Hilmi Çekin, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Emin Durmuş, is at Department of Radiology, Antalya Atatürk Public Hospital, Antalya, Turkey
| | - İbrahim Şenel Yalçın
- Serkan Öcal, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Merve Eren Durmusş, MD, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- İbrahim Şenel Yalçn, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ahmet Şükrü Alparslan, is at Department of Radiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ayhan Hilmi Çekin, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Emin Durmuş, is at Department of Radiology, Antalya Atatürk Public Hospital, Antalya, Turkey
| | - Ahmet Şükrü Alparslan
- Serkan Öcal, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Merve Eren Durmusş, MD, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- İbrahim Şenel Yalçn, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ahmet Şükrü Alparslan, is at Department of Radiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ayhan Hilmi Çekin, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Emin Durmuş, is at Department of Radiology, Antalya Atatürk Public Hospital, Antalya, Turkey
| | - Ayhan Hilmi Çekin
- Serkan Öcal, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Merve Eren Durmusş, MD, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- İbrahim Şenel Yalçn, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ahmet Şükrü Alparslan, is at Department of Radiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ayhan Hilmi Çekin, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Emin Durmuş, is at Department of Radiology, Antalya Atatürk Public Hospital, Antalya, Turkey
| | - Emin Durmuş
- Serkan Öcal, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Merve Eren Durmusş, MD, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- İbrahim Şenel Yalçn, is at Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ahmet Şükrü Alparslan, is at Department of Radiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Ayhan Hilmi Çekin, is at Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
- Emin Durmuş, is at Department of Radiology, Antalya Atatürk Public Hospital, Antalya, Turkey
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Bastamizad N, Abbasi P, Salari N, Jalali R. Comparing the Effect of Incentive Spirometry and Deep Breathing Exercises on the Level of Shoulder Pain and Nausea Following Laparoscopic Cholecystectomy Surgery: A Clinical Trial Study. Gastroenterol Nurs 2023; 46:14-22. [PMID: 36706138 DOI: 10.1097/sga.0000000000000720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 04/01/2022] [Indexed: 01/28/2023] Open
Abstract
Cholecystitis treated by laparoscopy results in patients experiencing shoulder pain and nausea. Thus, the aim of the present study was to compare the effect of incentive spirometry and deep breathing exercises on the level of shoulder pain and nausea following laparoscopy. In this clinical trial, 105 patients were enrolled into three groups: use of incentive spirometry, deep breathing exercises, and control. Data were collected using a checklist and a visual analog scale and analyzed through the χ2, the Kruskal-Wallis, the Friedman, and the paired t test by SPSS Version 25. In the deep breathing exercise, incentive spirometry, and control groups, mean pain scores immediately after surgery but within 24 hours following the intervention were 3.8, 2.6, and 4.4, respectively. The mean score of severity of nausea for patients in the deep breathing exercise and incentive spirometry groups showed a significant difference immediately after the procedure, as well as at 12 and 24 hours post-intervention. Breathing exercises and incentive spirometry can be effective in reducing pain and nausea in patients undergoing cholecystectomy through laparoscopy. Because of the effectiveness of the two methods, nurses can use incentive spirometery and deep breathing exercises to diminish patients' pain post-cholecystectomy.
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Affiliation(s)
- Nasrin Bastamizad
- Nasrin Bastamizad, MSc, is Nurse, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Parvin Abbasi, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Nader Salari, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Rostam Jalali, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parvin Abbasi
- Nasrin Bastamizad, MSc, is Nurse, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Parvin Abbasi, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Nader Salari, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Rostam Jalali, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nader Salari
- Nasrin Bastamizad, MSc, is Nurse, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Parvin Abbasi, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Nader Salari, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Rostam Jalali, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rostam Jalali
- Nasrin Bastamizad, MSc, is Nurse, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Parvin Abbasi, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Nader Salari, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Rostam Jalali, PhD, is Faculty Member, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Ohno A, Fujimori N, Kaku T, Hijioka M, Kawabe K, Harada N, Nakamuta M, Oono T, Ogawa Y. The feasibility of percutaneous transhepatic gallbladder aspiration for acute cholecystitis after self-expandable metallic stent placement for malignant biliary obstruction: a 10-year retrospective analysis in a single center. Clin Endosc 2022; 55:784-792. [PMID: 36266237 PMCID: PMC9726445 DOI: 10.5946/ce.2021.244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 02/25/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/AIMS Patients with acute cholecystitis (AC) after metallic stent (MS) placement for malignant biliary obstruction (MBO) have a high surgical risk. We performed percutaneous transhepatic gallbladder aspiration (PTGBA) as the first treatment for AC. We aimed to identify the risk factors for AC after MS placement and the poor response factors of PTGBA. METHODS We enrolled 401 patients who underwent MS placement for MBO between April 2011 and March 2020. The incidence of AC was 10.7%. Of these 43 patients, 37 underwent PTGBA as the first treatment. The patients' responses to PTGBA were divided into good and poor response groups. RESULTS There were 20 patients in good response group and 17 patients in poor response group. Risk factors for cholecystitis after MS placement included cystic duct obstruction (p<0.001) and covered MS (p<0.001). Cystic duct obstruction (p=0.003) and uncovered MS (p=0.011) demonstrated significantly poor responses to PTGBA. Cystic duct obstruction is a risk factor for cholecystitis and poor response factor for PTGBA, whereas covered MS is a risk factor for cholecystitis and an uncovered MS is a poor response factor of PTGBA for cholecystitis. CONCLUSION The onset and poor response factors of AC after MS placement were different between covered and uncovered MS. PTGBA can be a viable option for AC after MS placement, especially in patients with covered MS.
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Affiliation(s)
- Akihisa Ohno
- Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan,Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nao Fujimori
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toyoma Kaku
- Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan,Correspondence: Toyoma Kaku Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan E-mail:
| | - Masayuki Hijioka
- Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Ken Kawabe
- Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Naohiko Harada
- Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Makoto Nakamuta
- Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Takamasa Oono
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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30
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Synchronous gallbladder perforation and appendicitis in a pediatric patient. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Goto K, Shimizu Y, Kojima T, Takeda N, Fujiu K, Komuro I. Cholecystitis and Cholangitis during Continuous Renal Replacement Therapy in a Patient with Retroperitoneal Hemorrhage Requiring Large Amounts of Contrast Medium for the Assessment and Intervention. Intern Med 2022; 61:2533-2537. [PMID: 35110479 PMCID: PMC9449612 DOI: 10.2169/internalmedicine.8518-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Intravenous use of contrast medium (CM), which may cause kidney dysfunction, is admissible for hemodialysis patients because of the efficient removal by hemodialysis. We herein report a 61-year-old woman on hemodialysis who suffered from cholecystitis and cholangitis after large-volume CM administration during continuous renal replacement therapy. After catheter ablation, she developed life-threatening retroperitoneal hemorrhage, which led to the use of 500 mL CM for 5 consecutive days. It should be kept in mind that excessive vicarious CM excretion in the biliary system may become a predisposing factor of cholecystitis and cholangitis in patients who frequently undergo radiological interventions and imaging.
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Affiliation(s)
- Kohsaku Goto
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Yu Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Toshiya Kojima
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Japan
- Department of Advanced Cardiology, The University of Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Japan
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Gaisinskaya P, Sugerik S, Gebara CM. Acalculous Cholecystitis Secondary to Hepatitis C Infection. Cureus 2022; 14:e26484. [PMID: 35919206 PMCID: PMC9339148 DOI: 10.7759/cureus.26484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/01/2022] [Indexed: 12/05/2022] Open
Abstract
Acute acalculous cholecystitis (AAC) represents gallbladder inflammation without evidence of gallstones. This typically results from gallbladder stasis and/or ischemia, which then causes a local inflammatory response within the wall. The condition is typically multifactorial and seen in critically ill patients, with associated risk factors that include trauma, burns, infections, total parenteral nutrition, and surgery. We present the case of a patient with acute-on-chronic hepatitis C infection leading to AAC.
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Garmpi A, Damaskos C, Garmpis N, Georgakopoulou VE, Kaminiotis VV, Diamantis E, Patsouras A, Syllaios A, Dimitroulis D. All that Glitters is not Cholecystitis. A Rare Presentation of Acute Pericarditis Mimicking Cholecystitis and Review of the Literature. Acta Med Litu 2022; 29:217-224. [PMID: 37733419 PMCID: PMC9798999 DOI: 10.15388/amed.2022.29.2.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 11/22/2022] Open
Abstract
Acute pericarditis is the most common inflammatory disorder of the pericardium, responsible for approximately 5% of visits to the emergency departments, concerning chest pain without myocardial infarction. We report a case of a 41-year-old man who presented to our hospital, complaining about retrosternal and epigastrium pain. The transthoracic echocardiogram showed pericardial effusion while the electrocardiogram and laboratory findings revealed acute pericarditis. An abdominal ultrasound revealed gallbladder edema. The pericardial effusion was treated with pericardial catheter insertion, diuretics, and nonsteroidal anti-inflammatory drugs. This case shows that acute pericarditis can be clinically presented with many ways, one of them being gallbladder edema. Furthermore, in this case-based review we present all cases of simultaneous appearance of pericarditis and acalculous cholecystitis or gallbladder edema.
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Affiliation(s)
- Anna Garmpi
- First Department of Propedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Damaskos
- Renal Transplantation Unit, Laiko General Hospital, Athens, Greece
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Garmpis
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Evangelos Diamantis
- Academic Department of Internal Medicine - Endocrinology Unit, Agioi Anargyroi General Oncology Hospital of Kifisia, National and Kapodistrian University of Athens Athens Greece
| | | | - Athanasios Syllaios
- First Department of Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Dimitroulis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Lee WY. Spontaneous acalculous gallbladder perforation mimicking duodenal stump leak after gastrectomy for gastric cancer: A case report. Int J Surg Case Rep 2022; 96:107304. [PMID: 35738140 PMCID: PMC9218806 DOI: 10.1016/j.ijscr.2022.107304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/08/2022] [Accepted: 06/11/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Spontaneous gallbladder (GB) perforation is a rare and severe condition. Herein, we present a case of spontaneous acalculous gallbladder perforation mimicking duodenal stump leak after a subtotal gastrectomy for gastric cancer. CASE PRESENTATION An 83-year-old woman underwent a radical subtotal gastrectomy for advanced gastric cancer. On postoperative day 5, mild leukocytosis was observed. A computed tomography (CT) scan revealed a slightly distended non-thickened GB with minimal air and fluid collection near the duodenal stump, and fluid collection in the abdominal and pelvic cavities. We considered a duodenal stump leak. The effluent of the Barovac located in the abdominal cavity was serosanguinous and the patient was stable, thus we observed and continued using antibiotics. On day 13, the Barovac stopped functioning properly, so we replaced it with a percutaneous catheter drain (PCD) under ultrasonography guidance, aided by the Barovac tract. The PCD drained over 1000 cc of bile daily. On day 16, a follow-up CT showed an increased fluid collection in the abdominopelvic cavity. After comparing this with the previous CT, we rediagnosed as spontaneous GB perforation. An emergency cholecystectomy was performed. Postoperatively, the patient's condition returned to normal and antibiotic therapy continued until day 14. The patient recovered without other complications and was discharged on day 28. CLINICAL DISCUSSION Spontaneous GB perforation is a rare but serious complication immediately after gastrectomy which should be looked out for. CONCLUSION We report a rare case of spontaneous GB perforation mimicking duodenal stump leak after radical subtotal gastrectomy in gastric cancer.
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Affiliation(s)
- Woo Yong Lee
- Department of Surgery, Inje University Haeundae Paik Hospital, 875 Haeunda-ro, Haeundae-gu, Busan 48108, Republic of Korea.
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Gastrointestinal Ischemia—Stumbling Stone in COVID-19 Patients. GASTROENTEROLOGY INSIGHTS 2022. [DOI: 10.3390/gastroent13020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The emergence of the novel SARS-CoV2 virus, proclaimed by the World Health Organization (WHO) as a culpable agent for the pandemic situation, caught the scientific and medical communities off guard. One of the most common complications following pulmonary disease is represented by gastrointestinal (GI) disorders, especially ischemic damage. Inflammation, vasculopathy, immobility, endothelial dysfunction, and a hypercoagulable condition have all been proposed as pathophysiological factors for GI ischemia in these patients. Owing to the COVID-19 effect on a variety of GI conditions, especially ischemic changes, and the high mortality rate, physicians should always keep in mind this complication. They should take a deeper look at clinical and imaging modalities in this cohort of patients so that a proper and time-saving treatment strategy can be applied. Our study aimed to elucidate the thrombogenic mechanism in different GI disorders. Moreover, we analyzed the factors related to necrotic GI changes, by summarizing the already reported data of GI ischemia in COVID-19. To the best of our knowledge, this review is the first to incorporate all GI ischemia cases reported in the literature so far.
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Saragò M, Fiore D, De Rosa S, Amaddeo A, Pulitanò L, Bozzarello C, Iannello AM, Sammarco G, Indolfi C, Rizzuto A. Acute acalculous cholecystitis and cardiovascular disease, which came first? After two hundred years still the classic chicken and eggs debate: A review of literature. Ann Med Surg (Lond) 2022; 78:103668. [PMID: 35734727 PMCID: PMC9206910 DOI: 10.1016/j.amsu.2022.103668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
The existence of a close association between disease of the biliary tract and disease of the heart is known from the mists of time. Acute acalculous cholecystitis (AAC) can be defined as an acute necro inflammatory disease of the gallbladder in the absence of cholelithiasis. AAC is a challenging diagnosis. The atypical clinical onset associated to a paucity and similarity of symptoms and to laboratory data mimicking cardiovascular disease (CVD) often results in under and misdiagnosed cases. Moreover, AAC has commonly a fulminant course compared to calculous cholecystitis and it is often associated with gangrene, perforation and empyema as well as considerable morbidity and mortality (up 50%). Early diagnosis is crucial to a prompt treatment in order to avoid complications and to increase survivability. Even today, although scientific evidence dating two hundred years has shown a close association between AAC and CVD, due to the lack of RCT, there is still a lot of confusion regarding the relationship and consequently the clinical management AAC and CVD. In addition, emergency physicians are not always familiar with transient ECG changes with AAC. The aim of this review was to provide evidence regarding epidemiology, pathophysiology, clinical presentation and treatment of the complex association between AAC and CVD. Our main findings indicate that AAC should be suspected after each general disease leading to hypoperfusion such as cardiovascular diseases or cerebrovascular diseases or major heart or aortic surgery. ECG changes in absence of significant laboratory data for IMA (Acute myocardial infarction) could be related to a misdiagnosed AAC. US – Ultrasonography-plays a key role in the early diagnosis and also in the follow up of AAC. Cholecystostomy and cholecystectomy as unique or sequential represent the two prevailing treatment options for AAC.
AAC should be suspected after each general disease leading to hypoperfusion such as cardiovascular diseases or cerebrovascular diseases or major heart or aortic surgery. ECG changes in absence of significant laboratory data for IMA could be related to a misdiagnosed AAC. Cholecystectomy is an only definitive treatment for AAC. The first report on this theme after 20 years.
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Cortellazzo Wiel L, Spezzacatene A, Gortani G, Saccari A, Taddio A, Barbi E. Acute Acalculous Cholecystitis: Think of Hepatitis A Infection and Do Not Underestimate Pain. Pediatr Emerg Care 2022; 38:304-306. [PMID: 35477693 DOI: 10.1097/pec.0000000000002735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
ABSTRACT A 14-year-old adolescent girl presented with severe abdominal pain, tenderness, and guarding in the right upper quadrant associated with nonbilious vomiting, scleral icterus, and fever. Laboratory tests were consistent with acute hepatitis A virus-related cholestatic hepatitis. A point-of-care ultrasound showed mild gallbladder wall thickening with increased color Doppler flow and pericholecystic fluid collection, in the absence of gallstones or biliary ducts dilatation, thus suggesting acute acalculous cholecystitis. Both the clinical symptoms and the point-of-care ultrasound findings completely resolved within 1 week after admission with conservative treatment.
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Affiliation(s)
| | - Anita Spezzacatene
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Giulia Gortani
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Alessia Saccari
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
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Chen SY, Huang R, Kallini J, Wachsman AM, Van Allan RJ, Margulies DR, Phillips EH, Barmparas G. Outcomes Following Percutaneous Cholecystostomy Tube Placement for Acalculous Versus Calculous Cholecystitis. World J Surg 2022; 46:1886-1895. [DOI: 10.1007/s00268-022-06566-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
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Overlooked but Serious Gallbladder Disease during Extracorporeal Membrane Oxygenation: A Retrospective Analysis. J Clin Med 2022; 11:jcm11082199. [PMID: 35456290 PMCID: PMC9031104 DOI: 10.3390/jcm11082199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/09/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background: To date, there have been no reports assessing the incidence, risk factors, and clinical outcomes of GB disease in patients receiving ECMO for cardiorespiratory failure. Methods: The medical records of adults (aged > 18 years) who underwent ECMO between May 2010 and October 2019 were retrospectively reviewed. We investigated the prevalence and related factors of GB disease during ECMO therapy, compared clinical outcomes between patients with and without GB disease, and performed propensity-matched analysis. Results: In total, 446 patients were included, and symptomatic GB disease was found in 62 patients (13.9%, 76.2/1000 ECMO days). Complicated GB disease occurred in 42 patients (9.4%, 89.4/1000 ECMO days) and presented as acute cholecystitis, acute cholangitis, and biliary pancreatitis in 33 (7.4%), 7 (1.6%), and 5 (1.1%) patients, respectively. In multivariate Cox regression analysis, longer ECMO support (>2 weeks) (hazard ratio (HR), 2.95; 95% confidence interval (CI), 1.69−5.15) and elevated plasma hemoglobin (Hb, >50 mg/dL) (HR. 2.12; 95% CI, 1.18−3.78) were significantly associated with the development of GB disease. In the propensity-matched cohort, the intensive care unit (ICU) and hospital survival rates were significantly lower for patients with GB disease than for those without GB disease (ICU survival rate, 64.5% vs. 84.7%; hospital survival rate, 59.7% vs. 81.5%). Conclusion: The incidence of GB disease was higher in patients who received ECMO than in the general ICU patients. Furthermore, elevated plasma Hb and prolonged ECMO therapy were significant factors for the development of GB disease during ECMO therapy.
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Abstract
IMPORTANCE Gallbladder disease affects approximately 20 million people in the US. Acute cholecystitis is diagnosed in approximately 200 000 people in the US each year. OBSERVATIONS Gallstone-associated cystic duct obstruction is responsible for 90% to 95% of the cases of acute cholecystitis. Approximately 5% to 10% of patients with acute cholecystitis have acalculous cholecystitis, defined as acute inflammation of the gallbladder without gallstones, typically in the setting of severe critical illness. The typical presentation of acute cholecystitis consists of acute right upper quadrant pain, fever, and nausea that may be associated with eating and physical examination findings of right upper quadrant tenderness. Ultrasonography of the right upper quadrant has a sensitivity of approximately 81% and a specificity of approximately 83% for the diagnosis of acute cholecystitis. When an ultrasound result does not provide a definitive diagnosis, hepatobiliary scintigraphy (a nuclear medicine study that includes the intravenous injection of a radiotracer excreted in the bile) is the gold standard diagnostic test. Following diagnosis, early (performed within 1-3 days) vs late (performed after 3 days) laparoscopic cholecystectomy is associated with improved patient outcomes, including fewer composite postoperative complications (11.8% for early vs 34.4% for late), a shorter length of hospital stay (5.4 days vs 10.0 days), and lower hospital costs. During pregnancy, early laparoscopic cholecystectomy, compared with delayed operative management, is associated with a lower risk of maternal-fetal complications (1.6% for early vs 18.4% for delayed) and is recommended during all trimesters. In people older than 65 years of age, laparoscopic cholecystectomy is associated with lower mortality at 2-year follow-up (15.2%) compared with nonoperative management (29.3%). A percutaneous cholecystostomy tube, in which a drainage catheter is placed in the gallbladder lumen under image guidance, is an effective therapy for patients with an exceptionally high perioperative risk. However, percutaneous cholecystostomy tube placement in a randomized trial was associated with higher rates of postprocedural complications (65%) compared with laparoscopic cholecystectomy (12%). For patients with acalculous acute cholecystitis, percutaneous cholecystostomy tube should be reserved for patients who are severely ill at the time of diagnosis; all others should undergo a laparoscopic cholecystectomy. CONCLUSIONS AND RELEVANCE Acute cholecystitis, typically due to gallstone obstruction of the cystic duct, affects approximately 200 000 people in the US annually. In most patient populations, laparoscopic cholecystectomy, performed within 3 days of diagnosis, is the first-line therapy for acute cholecystitis.
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Affiliation(s)
- Jared R Gallaher
- Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill
| | - Anthony Charles
- Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill
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Heo J, Jung MK, Cho CM, Lee SY, Ryeom HK, Chun JM, Han YS, Kwon HJ. What makes acute cholecystitis recur after removing the percutaneous cholecystostomy tube? Medicine (Baltimore) 2022; 101:e28767. [PMID: 35119038 PMCID: PMC8812646 DOI: 10.1097/md.0000000000028767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 01/14/2022] [Indexed: 01/04/2023] Open
Abstract
Percutaneous transhepatic gallbladder drainage (PTGBD) is an alternative treatment option for acute cholecystitis. However, the disease may recur after PTGBD catheter removal. This study aimed to evaluate the role of endoscopic sphincterotomy and other risk factors in reducing the recurrence of cholecystitis.We retrospectively analyzed data from 1088 patients who underwent PTGBD for cholecystitis at Kyungpook National University Hospital, Republic of Korea, between January 2011 and April 2018.A total of 115 patients were enrolled in the study. The recurrence rate of cholecystitis was 17.4% (n = 20) during a median follow-up period of 1159 (range, 369-2774) days. Endoscopic biliary sphincterotomy did not significantly affect the recurrence rate of cholecystitis (P = .561). In multivariable analysis, cystic duct stones (P = .013) and PTGBD catheter migration before the prescheduled removal time (P = .002) were identified as independent risk factors for cholecystitis recurrence after PTGBD.To reduce post-PTGBD recurrence in cholecystitis, caution must be exercised to avoid inadvertent dislodging of the PTGBD catheter. In cases of cholecystitis with cystic duct stones, cholecystectomy should be considered only after careful assessment of postoperative risks. Instead, transluminal endoscopic gallbladder drainage could represent a promising option for the prevention of recurrent cholecystitis.
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Affiliation(s)
- Jun Heo
- School of Medicine, Kyungpook National University, Daegu, the Republic of Korea
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, the Republic of Korea
| | - Min Kyu Jung
- School of Medicine, Kyungpook National University, Daegu, the Republic of Korea
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, the Republic of Korea
| | - Chang Min Cho
- School of Medicine, Kyungpook National University, Daegu, the Republic of Korea
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, the Republic of Korea
| | - Sang Yub Lee
- School of Medicine, Kyungpook National University, Daegu, the Republic of Korea
- Department of Radiology, Kyungpook National University Hospital, Daegu, the Republic of Korea
| | - Hun Kyu Ryeom
- School of Medicine, Kyungpook National University, Daegu, the Republic of Korea
- Department of Radiology, Kyungpook National University Hospital, Daegu, the Republic of Korea
| | - Jae Min Chun
- School of Medicine, Kyungpook National University, Daegu, the Republic of Korea
- Department of Surgery, Kyungpook National University Hospital, Daegu, the Republic of Korea
| | - Young Seok Han
- School of Medicine, Kyungpook National University, Daegu, the Republic of Korea
- Department of Surgery, Kyungpook National University Hospital, Daegu, the Republic of Korea
| | - Hyung Jun Kwon
- School of Medicine, Kyungpook National University, Daegu, the Republic of Korea
- Department of Surgery, Kyungpook National University Hospital, Daegu, the Republic of Korea
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Fosio M, Cherobin G, Stramare R, Fassan M, Giraudo C. Coronary Artery Disease and Gallbladder Inflammatory Pseudopolyps. Diagnostics (Basel) 2022; 12:155. [PMID: 35054322 PMCID: PMC8774625 DOI: 10.3390/diagnostics12010155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 11/16/2022] Open
Abstract
Axial MR image demonstrating multiple small gallbladder polypoid lesions characterized by contrast enhancement in a 78-year-old male hospitalized for acute chest pain due to coronary artery disease who showed fever and emesis during hospitalization and had signs of acute acalculous cholecystitis at computed tomography. Given the overall clinical conditions and the MR features, the inflammatory origin of the polyps was considered. The patient underwent cholecystectomy and the histological diagnosis of gallbladder inflammatory pseudopolyps was confirmed. This rare entity represents 5-10% of all gallbladder polyps, and their differentiation from benign and malignant tumors might be challenging especially in acalculous patients, thus surgery is often performed.
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Affiliation(s)
- Margherita Fosio
- UOSD Imaging Avanzato Clinico e Translazionale, Department of Medicine, University of Padova, 35127 Padova, Italy; (M.F.); (G.C.); (R.S.)
| | - Giulia Cherobin
- UOSD Imaging Avanzato Clinico e Translazionale, Department of Medicine, University of Padova, 35127 Padova, Italy; (M.F.); (G.C.); (R.S.)
| | - Roberto Stramare
- UOSD Imaging Avanzato Clinico e Translazionale, Department of Medicine, University of Padova, 35127 Padova, Italy; (M.F.); (G.C.); (R.S.)
| | - Matteo Fassan
- Surgical Pathology, Department of Medicine, University of Padova, 35121 Padova, Italy;
- Veneto Institute of Oncology, IOV-IRCCS, 35128 Padova, Italy
| | - Chiara Giraudo
- UOSD Imaging Avanzato Clinico e Translazionale, Department of Medicine, University of Padova, 35127 Padova, Italy; (M.F.); (G.C.); (R.S.)
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Chen BQ, Chen GD, Xie F, Li X, Mao X, Jia B. Percutaneous cholecystostomy as a definitive treatment for moderate and severe acute acalculous cholecystitis: a retrospective observational study. BMC Surg 2021; 21:439. [PMID: 34961498 PMCID: PMC8713395 DOI: 10.1186/s12893-021-01411-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/24/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In this study, we aimed to investigate risk factors for the relapse of moderate and severe acute acalculous cholecystitis (AAC) patients after initial percutaneous cholecystostomy (PC) and to identify the predictors of patient outcomes when choosing PC as a definitive treatment for AAC. MATERIALS AND METHODS The study population comprised 44 patients (median age 76 years; range 31-94 years) with moderate or severe AAC who underwent PC without subsequent cholecystectomy. According to the results of follow-up (followed for a median period of 17 months), the data of patients with recurrence versus no recurrence were compared. Patients were divided into the death and non-death groups based on patient status within 60 days after PC. RESULTS Twenty-one (47.7%) had no recurrence of cholecystitis during the follow-up period after catheter removal (61-1348 days), six (13.6%) experienced recurrence of cholecystitis after PC, and 17 (38.6%) patients died during the indwelling tube period (5-60 days). The multivariate analysis showed that coronary heart disease (CHD) or congestive heart failure (odds ratio [OR] 26.50; 95% confidence interval [CI] 1.21-582.06; P = 0.038) was positively correlated with recurrence. The age-adjusted Charlson comorbidity index (OR 1.53; 95% CI 1.08-2.17; P = 0.018) was independently associated with 60-day mortality after PC. CONCLUSIONS Our results suggest that CHD or congestive heart failure was an independent risk factor for relapse in moderate and severe AAC patients after initial PC. AAC patients with more comorbidities had worse outcomes.
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Affiliation(s)
- Bai-Qing Chen
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
| | - Guo-Dong Chen
- Department of Radiology, Panjin Liaohe Oilfield Gem Flower Hospital, 26 Yingbin Road, Xinglongtai District, Panjin, 124010, China
| | - Feng Xie
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China.
| | - Xue Li
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
| | - Xue Mao
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
| | - Bao Jia
- Department of Nuclear Medicine, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
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Effects of Serum Metabolites on the Pancreatic Transcriptome in Acute Acalculous Cholecystitis. Gastroenterol Res Pract 2021; 2021:2368571. [PMID: 34925503 PMCID: PMC8674085 DOI: 10.1155/2021/2368571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/15/2021] [Indexed: 01/30/2023] Open
Abstract
Background To provide a basis for the diagnosis and treatment of acalculous biliary pancreatitis, this study investigated the impact of serum metabolites on the pancreatic transcriptome in acute acalculous cholecystitis (AAC). Methods Fourteen rabbits were randomly divided into two groups (a normal control group of 7 rabbits and an AAC group of 7 rabbits), blood was collected from the 14 rabbits, and metabolomic analysis was performed through 1H NMR. Two pancreatic tissue chips of the AAC group and the normal control group were prepared and sequenced. We utilized the limma package of R software, the DAVID database, the STRING database, Cytoscape software, and the CFinder analysis tool to perform differential expression gene analysis, gene function enrichment analysis, protein interaction network (PPI) construction, and network module mining, and we performed gene enrichment analysis in each module. Results Serum metabolism analysis showed that in AAC, the metabolism of sugar, lipids, and protein, that is, the three major nutrients, was affected to varying degrees, and levels of serum trimethylamine N-oxide (TMAO) increased. Bioinformatic methods were utilized to identify a total of 183 differentially expressed genes and 3 key genes. Enrichment analysis showed that differentially expressed genes were significantly enriched in cation transport, the inflammatory response, the NF-κB pathway, and the cancer signaling pathway. Conclusion Metabolomic analysis and functional analysis of 3 key genes demonstrated that abnormal serum metabolites affected the pancreatic transcriptome and induced a sensitive state of inflammation in the pancreas. These metabolites may represent important targets for future research on the pathogenesis, clinical diagnosis, and treatment of noncalculous biliary pancreatitis.
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Kamei J, Kuriyama A, Shimamoto T, Komiya T. Incidence and risk factors of acute cholecystitis after cardiovascular surgery. Gen Thorac Cardiovasc Surg 2021; 70:611-618. [PMID: 34846684 DOI: 10.1007/s11748-021-01751-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/21/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Acute cholecystitis is a complication in critically ill patients. However, a few studies have described its incidence, risk factors, and mortality in patients who underwent cardiovascular surgery. We investigated the incidence, perioperative predictors, and clinical features of acute cholecystitis after cardiovascular surgery. METHODS This retrospective cohort study examined 7013 patients who underwent cardiovascular surgery between October 2000 and March 2019 at a tertiary care hospital. We collected preoperative, intraoperative, and postoperative data from our database and electronic medical records. The primary outcome was the incidence of postoperative cholecystitis until hospital discharge. A multivariable logistic regression analysis to estimate perioperative predictors of acute cholecystitis was conducted. We described the clinical characteristics of patients complicated with acute cholecystitis. RESULTS Among the 7013 patients, 51 (0.7%) developed acute cholecystitis. Logistic regression analysis found that circulatory arrest (odds ratio [OR] 1.97; 95% confidence interval [CI] 1.04-3.74; P = 0.037) and intraoperative massive transfusion (OR 2.03; 95% CI 1.03-4.01; P = 0.041) were associated with the incidences of cholecystitis. In-hospital mortality was significantly higher in the cholecystitis group than in the non-cholecystitis group (13.7% vs 3.9%, P = 0.004). Aortic disease was more frequent in the cholecystitis group (54.9% vs 38.6%, P = 0.021). The median time of acute cholecystitis onset from surgery was 12.5 days (interquartile range 7.0-27.75). Twenty-six patients (51.0%) developed asymptomatic cholecystitis. CONCLUSIONS Approximately 1% of patients who underwent cardiovascular surgery developed postoperative cholecystitis; half of them were asymptomatic. Since cholecystitis is associated with high mortality, it is a complication after cardiovascular surgery that needs to be considered.
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Affiliation(s)
- Jun Kamei
- Emergency and Critical Care Center, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan.
| | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Takeshi Shimamoto
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan
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Lin Q, Shen L, Chen C, Yang Z, Que Y, Liu Y, Yin M, Xu G, Li J. Prognostic Significance of Ultrasound Findings of Acute Acalculous Cholecystitis for Elderly Long-Term Bedridden Patients. Front Med (Lausanne) 2021; 8:743998. [PMID: 34692734 PMCID: PMC8531473 DOI: 10.3389/fmed.2021.743998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/13/2021] [Indexed: 12/07/2022] Open
Abstract
Background: Acute acalculous cholecystitis (AAC) is characterized by the development of cholecystitis in the gallbladder without gallstones or with small gallstones unrelated to inflammatory diseases. This disease is not rare in the elderly bedridden patients with co-morbidities and prone to develop life-threatening gangrene or perforation of gallbladder. Early imaging is essential for detecting and effectively treating AAC. This study aimed to evaluate the use of ultrasound diagnostic criteria for the diagnosis and prognosis of elderly long-term bedridden patients with suspected AAC. Methods: We retrospectively studied 374 elderly bedridden patients with clinical manifestations of AC at the acute stage of the disease. Gallbladder anomalies were found in 92 patients by ultrasound examination, which correlated with the duration time of clinical manifestations, complications, as well as therapeutic prognosis. The major and minor ultrasound criteria of AAC were made according to the Tokyo Guidelines 2018. Ultrasound results were thought to be AAC positive when they met two major criteria or one major and two minor criteria. Results: Forty-three (46.7%) of the 92 patients presented with AAC (+) test results based on the ultrasound criteria, with a higher incidence of complications (27.9%) than AAC (–) patients (0%; P < 0.001). The median length of symptoms (8 vs. 4 days, P < 0.001) and duration of antibiotic therapy (13 vs. 5 days, P < 0.001) were longer in the AAC (+) group. Conclusions: The ultrasound-based AAC (+) group often had a worse prognosis than the AAC (–) group. Therefore, patients from the AAC (+) group should receive a follow-up ultrasound examination to detect disease progression early.
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Affiliation(s)
- Qian Lin
- Department of Medical Ultrasonics, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Lei Shen
- Department of Gastroenterology, Faculty of Digestive Medicine, The First Medical Center, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Cheng Chen
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Zhen Yang
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Yifan Que
- Department of Geriatric Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Yani Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ming Yin
- Department of Emergency, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Guogang Xu
- Department of Geriatric Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Junlai Li
- Department of Medical Ultrasonics, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
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Fu Y, Pang L, Dai W, Wu S, Kong J. Advances in the Study of Acute Acalculous Cholecystitis: A Comprehensive Review. Dig Dis 2021; 40:468-478. [PMID: 34657038 DOI: 10.1159/000520025] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/01/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Acute acalculous cholecystitis (AAC) is characterized by acute necrotizing inflammation with no calculi and is diagnosed based on imaging, intraoperative, and pathological examinations. KEY MESSAGE Although AAC has been studied clinically for a long time, it remains difficult to diagnose and treat. The pathogenesis of AAC is still not fully understood, and it is often regarded as a relatively independent clinical disease that is different from acute calculous cholecystitis (ACC). Pathological studies suggest that AAC is the manifestation of a critical systemic disease, while ACC is a local disease of the gallbladder. SUMMARY Concerning the pathogenesis, diagnosis, and treatment of AAC, we reviewed the research progress of AAC, which will enhance the understanding of the early diagnosis and treatment of AAC.
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Affiliation(s)
- Yantao Fu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liwei Pang
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wanlin Dai
- Innovation Institute of China Medical University, Shenyang, China
| | - Shuodong Wu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Kong
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
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Cecire J, Sutherland A, Das KK. Gallbladder Torsion Masking as Acalculus Cholecystitis: A Review of Two Cases Including Unsuccessful Management With Percutaneous Cholecystostomy. J Med Cases 2021; 12:223-225. [PMID: 34434462 PMCID: PMC8383507 DOI: 10.14740/jmc3683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022] Open
Abstract
Gallbladder torsion is a rare cause of abdominal pain; however, it is important to diagnose pre-operatively. We report two cases of gallbladder torsion, both of which were not recognized until the time of surgery. Both patients were elderly thin females, presenting with right upper quadrant pain, and on examination had a positive Murphy’s sign, and pre-operative imaging was suggestive of acalculus cholecystitis. One patient was initially managed by percutaneous insertion of a cholecystostomy tube, with progression to a laparoscopic cholecystectomy after a failure of resolution of symptoms. The second patient was taken to theater shortly after presentation, with the gallbladder torsion recognized intra-operatively. In both cases, the gallbladder was distorted and a routine laparoscopic cholecystectomy was performed with good recovery following. These two cases highlight the need for gallbladder torsion to be considered as a diagnostic possibility in those presenting with right upper quadrant pain, particularly those groups at most risk, including elderly thin females. Whilst other causes of cholecystitis can be managed non-operatively, at least in the acute phase, gallbladder torsion requires urgent operative intervention.
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Affiliation(s)
- Jack Cecire
- Department of Surgery, Coffs Harbour Health Campus, Coffs Harbour, NSW, Australia
| | - Andrew Sutherland
- Department of Surgery, Coffs Harbour Health Campus, Coffs Harbour, NSW, Australia
| | - Kamala Kanta Das
- Department of Surgery, Coffs Harbour Health Campus, Coffs Harbour, NSW, Australia
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Yao Z, Tian W, Xu X, Zhao R, Zhao Y. Compared With a Nasointestinal Route, Pre-operative Enteral Nutrition via a Nasogastric Tube Reduced the Incidence of Acalculous Acute Cholecystitis After Definitive Surgery for Small Intestinal Fistula. Front Med (Lausanne) 2021; 8:721402. [PMID: 34485348 PMCID: PMC8415823 DOI: 10.3389/fmed.2021.721402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/27/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose: This study aimed to investigate the difference in the efficacy of pre-operative enteral nutrition (EN) via a nasogastric tube (NGT) and pre-operative EN via a nasointestinal tube (NIT) in reducing the incidence of post-operative acalculous acute cholecystitis (AAC) after definitive surgery (DS) for small intestinal fistulas. Methods: Patients with a small intestinal fistula, who had a DS for the disease between January 2015 and March 2021, were enrolled in this study. They were divided into the NIT group and the NGT group based on the pre-operative routes of feeding they received. The clinical characteristics of the two groups were analyzed, and the incidences of post-operative AAC in the two groups were evaluated. Results: A total of 200 patients were enrolled in the study, 85 in the NGT group and 115 in the NIT group. Thirty-one patients developed post-operative AAC (8 in the NGT group and 23 in the NIT group). The incidence of post-operative AAC was 15.5%. EN via the NGT route was associated with a reduction in the incidence of post-operative AAC (adjusted HR = 0.359; 95% CI: 0.139-0.931; P = 0.035). Conclusion: Pre-operative EN via the NGT may reduce the incidence of post-operative AAC in patients who received a DS for small intestinal fistulas.
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Affiliation(s)
- Zheng Yao
- Department of General Surgery, Jiangning Hospital, Nanjing, China
| | - Weiliang Tian
- Department of General Surgery, Jinling Hospital, Nanjing, China
| | - Xin Xu
- Department of General Surgery, Jiangning Hospital, Nanjing, China
| | - Risheng Zhao
- Department of General Surgery, Jiangning Hospital, Nanjing, China
| | - Yunzhao Zhao
- Department of General Surgery, Jiangning Hospital, Nanjing, China
- Department of General Surgery, Jinling Hospital, Nanjing, China
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50
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Markaki I, Konsoula A, Markaki L, Spernovasilis N, Papadakis M. Acute acalculous cholecystitis due to infectious causes. World J Clin Cases 2021; 9:6674-6685. [PMID: 34447814 PMCID: PMC8362504 DOI: 10.12998/wjcc.v9.i23.6674] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/08/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
Acute acalculous cholecystitis (AAC) is an inflammation of the gallbladder not associated with the presence of gallstones. It usually occurs in critically ill patients but it has also been implicated as a cause of cholecystitis in previously healthy individuals. In this subgroup of patients, infectious causes comprise the primary etiology. We, herein, discuss the pathophysiological mechanisms involved in AAC, focusing on the infectious causes. AAC associated with critical medical conditions is caused by bile stasis and gallbladder ischemia. Several mechanisms are reported to be involved in AAC in patients without underlying critical illness including direct invasion of the gallbladder epithelial cells, gallbladder vasculitis, obstruction of the biliary tree, and sequestration. We emphasize that multiple pathogenic mechanisms may concurrently contribute to the development of AAC in varying degrees. Awareness of the implicated pathogens is essential since it will allow a more focused examination of the histopathological specimens. In conclusion, additional research and a high degree of clinical suspicion are needed to clarify the complex spectrum of mechanisms that are involved in the pathogenesis of AAC.
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Affiliation(s)
- Ioulia Markaki
- Department of Emergency, General Hospital of Kythira “Trifyllio”, Kythira 80200, Greece
| | - Afroditi Konsoula
- Department of Emergency, General Hospital of Mytilene "Vostaneio", Lesvos 81132, Greece
| | - Lamprini Markaki
- Department of Pediatrics, "Agia Sofia" Children's Hospital, Athens 11527, Greece
| | | | - Marios Papadakis
- Department of Surgery II, University of Witten-Herdecke, Wuppertal 40235, NRW, Germany
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