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1
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Okazaki Y, Huh K, Ichiba T. Hepatic artery pseudoaneurysm complicated by pyogenic liver abscess. BMJ Case Rep 2024; 17:e262075. [PMID: 39638576 DOI: 10.1136/bcr-2024-262075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2024] Open
Affiliation(s)
- Yuji Okazaki
- Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kyungko Huh
- Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Toshihisa Ichiba
- Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
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Zhu RT, Li Y, Zhang CX, Wang WJ, Liang RP, Li J, Bai K, Sun YL. Acute suppurative terminal cholangitis: Clinical characteristics of a new subtype of acute cholangitis. Hepatobiliary Pancreat Dis Int 2024; 23:293-299. [PMID: 36690523 DOI: 10.1016/j.hbpd.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 01/09/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Acute suppurative terminal cholangitis (ASTC) is rarer than acute obstructive cholangitis and is not well studied. To explore this subtype of acute cholangitis, we described our clinical experience with ASTC. METHODS We performed a retrospective review of patients with ASTC admitted to our center from September 2014 to August 2020. We analyzed their clinical characteristics, including etiology, clinical manifestations, imaging features, treatment and prognosis. RESULTS A total of 32 ASTC patients were included in the analysis. The majority of the patients had a history of biliary operations, and clinical manifestations were occult and atypical. The positive rate of bacterial culture was 46.9%. All the patients had typical imaging features on computed tomography and magnetic resonance imaging. Treatment with effective antibiotics was provided as soon as diagnosis was established. After treatment, most patients had a good outcome. Elevated levels of total bilirubin, aspartate aminotransferase, procalcitonin and gamma-glutamyltransferase were the characteristics of critically ill patients and were associated with relatively poor prognosis. CONCLUSIONS Our results demonstrated that ASTC should be recognized as a new subtype of acute cholangitis, and that earlier diagnosis and more personalized treatments are needed.
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Affiliation(s)
- Rong-Tao Zhu
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Zhengzhou Key Laboratory of Hepatobiliary and Pancreatic Diseases, Zhengzhou 450052, China; Institute of Hepatobiliary and Pancreatic Diseases, Zhengzhou University, Zhengzhou 450052, China
| | - Ye Li
- Department of Pathology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Chi-Xian Zhang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Zhengzhou Key Laboratory of Hepatobiliary and Pancreatic Diseases, Zhengzhou 450052, China; Institute of Hepatobiliary and Pancreatic Diseases, Zhengzhou University, Zhengzhou 450052, China
| | - Wei-Jie Wang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Zhengzhou Key Laboratory of Hepatobiliary and Pancreatic Diseases, Zhengzhou 450052, China; Institute of Hepatobiliary and Pancreatic Diseases, Zhengzhou University, Zhengzhou 450052, China
| | - Ruo-Peng Liang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Zhengzhou Key Laboratory of Hepatobiliary and Pancreatic Diseases, Zhengzhou 450052, China; Institute of Hepatobiliary and Pancreatic Diseases, Zhengzhou University, Zhengzhou 450052, China
| | - Jian Li
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Zhengzhou Key Laboratory of Hepatobiliary and Pancreatic Diseases, Zhengzhou 450052, China; Institute of Hepatobiliary and Pancreatic Diseases, Zhengzhou University, Zhengzhou 450052, China
| | - Kai Bai
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Zhengzhou Key Laboratory of Hepatobiliary and Pancreatic Diseases, Zhengzhou 450052, China; Institute of Hepatobiliary and Pancreatic Diseases, Zhengzhou University, Zhengzhou 450052, China
| | - Yu-Ling Sun
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Zhengzhou Key Laboratory of Hepatobiliary and Pancreatic Diseases, Zhengzhou 450052, China; Institute of Hepatobiliary and Pancreatic Diseases, Zhengzhou University, Zhengzhou 450052, China.
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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] [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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Pathak SJ, Ji H, Nijagal A, Avila P, Dai SC, Arain MA, Kouanda A. Index admission cholecystectomy for acute cholecystitis reduces 30-day readmission rates in pediatric patients. Surg Endosc 2024; 38:1351-1357. [PMID: 38114877 PMCID: PMC10881756 DOI: 10.1007/s00464-023-10632-7] [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: 08/17/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Adult patients with cholecystitis who do not undergo cholecystectomy on index admission have worse outcomes, however, there is a paucity of data of the role of cholecystectomy during index hospitalization in the pediatric population. Our aim was to determine outcomes and readmission rates among pediatric patients with cholecystitis who underwent index cholecystectomy versus those who did not. METHODS We performed a retrospective study of pediatric (< 18 years old) admitted with acute cholecystitis (AC) requiring hospitalization using the 2018 National Readmission Database (NRD). Exclusion criteria included age ≥ 18 years and death on index admission. Multivariable logistic regression was performed to identify factors associated with 30-day readmissions. RESULTS We identified 550 unique index acute cholecystitis admissions. Mean age was 14.6 ± 3.0 years. Majority of patients were female (n = 372, 67.6%). Index cholecystectomy was performed in (n = 435, 79.1%) of cases. Thirty-day readmission rate was 2.8% in patients who underwent index cholecystectomy and 22.6% in those who did not (p < 0.001). On multivariable analysis, patients who did not undergo index cholecystectomy had higher odds of 30-day readmission than those who did not (OR 10.66, 95% CI 5.06-22.45, p < 0.001). Female patients also had higher odds of 30-day readmission compared to males (OR 3.37, 95% CI 1.31-8.69). CONCLUSIONS Patients who did not undergo index cholecystectomy had over tenfold increase in odds of 30-day readmission. Further research is required to understand the barriers to index cholecystectomy despite society recommendations and clear clinical benefit.
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Affiliation(s)
- Sagar J Pathak
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
| | - Hyun Ji
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Amar Nijagal
- Department of Surgery, University of California, San Francisco, CA, USA
- Liver Center, University of California, San Francisco, CA, USA
- The Pediatric Liver Center, UCSF Benioff Children's Hospital, San Francisco, CA, USA
- Eli and Edythe Broad Center of Regeneration Medicine, University of California, San Francisco, CA, USA
| | - Patrick Avila
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sun-Chuan Dai
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Mustafa A Arain
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Division of Gastroenterology, Department of Medicine, Center for Interventional Endoscopy, AdventHealth, Orlando, FL, USA
| | - Abdul Kouanda
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Roy DK, Sheikh R. A Systematic Review and Meta-Analysis of the Outcomes of Laparoscopic Cholecystectomy Compared to the Open Procedure in Patients with Gallbladder Disease. Avicenna J Med 2024; 14:3-21. [PMID: 38694141 PMCID: PMC11057899 DOI: 10.1055/s-0043-1777710] [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] [Indexed: 05/04/2024] Open
Abstract
Background Conflicting evidence regarding the laparoscopic versus open cholecystectomy outcomes in scientific literature impacts the medical decision-making for patients with gallbladder disease. This study aimed to compare a range of primary and secondary outcomes between patients receiving laparoscopic cholecystectomy and those with open intervention. Methods Articles published from 1993 to 2023 were explored by utilizing advanced filters of PubMed Central/Medline, Web of Science, CINAHL, JSTOR, Cochrane Library, Scopus, and EBSCO. The gallbladder disease was determined by the presence of one or more of the following conditions: 1) Gangrenous cholecystitis, 2) acute cholecystitis, 3) chronic gallbladder diseases, and 4) cholelithiasis. The primary end-point was mortality, while the secondary outcome included (1) bile leakage, 2) common bile duct injury, 3) gangrene, 4) hospital stay (days), 5) major complications, 6) median hospital stay (days), (7) pneumonia, 8) sick leaves (days), and 9) wound infection. Results Statistically significant reductions were observed in mortality (odds ratio [OR]: 0.30, 95% confidence interval [CI]: 0.30, 0.45, p < 0.00001), mean hospital stay duration (mean difference: -2.68, 95% CI: -3.66, -1.70, p < 0.00001), major complications (OR: 0.35, 95% CI: 0.19, 0.64, p = 0.0005), post/intraoperative wound infection (OR: 0.29, 95% CI: 0.16, 0.51, p < 0.0001), and sick leaves (OR: 0.34, 95% CI: 0.14, 0.80, p = 0.01) in patients who underwent laparoscopic cholecystectomy compared with those with the open intervention. No statistically significant differences were recorded between the study groups for bile leakage, common bile duct injury, gangrene, median hospital stay days, and pneumonia ( p > 0.05). Conclusions The pooled outcomes favored the use of laparoscopic cholecystectomy over the open procedure in patients with gallbladder disease. The consolidated findings indicate the higher impact of laparoscopic cholecystectomy in improving patient outcomes, including safety episodes, compared with open cholecystectomy.
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Affiliation(s)
- Debajit Kumar Roy
- Department of Surgery, R G Kar Medical College & Hospital, West Bengal University of Health Sciences, RG Kar Road, Kolkata, West Bengal, India
| | - Rahaman Sheikh
- Department of Anaesthesia, NRS Medical College, Kolkata, West Bengal, India
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Yuan Y, Tian W, Jin Z, Wang L, Zhu S. Cholecystitis in older patients following hip fracture: a case series and literature review. BMC Geriatr 2023; 23:694. [PMID: 37875814 PMCID: PMC10598889 DOI: 10.1186/s12877-023-04336-9] [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: 03/12/2023] [Accepted: 09/20/2023] [Indexed: 10/26/2023] Open
Abstract
OBJECTIVE This study's aim is to describe the characteristics of perioperative acute cholecystitis in older patients with hip fracture. METHODS From January 1, 2018, to April 30, 2023, 7,746 medical records were retrospectively collected for patients aged ≥ 65 years who were hospitalised for hip fracture in Beijing Jishuitan Hospital, Capital Medical University. We reviewed 10 cases with confirmed diagnoses of acute cholecystitis. RESULTS Of these 10 cases, five femoral neck fractures and five intertrochanteric fractures received orthopaedic surgery. The ratio of males to females was 2:8, the median age was 83.1 years (71-91 years), and there was a median BMI of 25.35 (15.56-35.16). 50% of cases had a poor functional capacity before fracture of below four metabolic equivalents. The median onset time of acute cholecystitis was five days (2-14 days) after fracture, including five cases before orthopaedic surgery and five cases after orthopaedic surgery. All patients had anorexia and fever during the course of the disease. In seven cases of calculous cholecystitis, two underwent percutaneous transhepatic biliary drainage, and one underwent percutaneous cholecystostomy. Two cases of calculous cholecystitis had poor prognosis; one died 49 days after fracture operation, and the reason for death was multiple organ failure caused by severe infection. The other one developed acute cerebellar infarction after gallbladder surgery through treatment in an intensive care unit and neurology department. The case was discharged with dysphasia, and the duration from fracture to discharge was 92 days. CONCLUSION This is the first study on the characteristics of acute cholecystitis in older patients with hip fracture in China. The incidence of acute cholecystitis in our study was 0.13%, with a high risk of in-hospital mortality and elevated hospitalisation costs. Our 10 cases with hip fractures accompanied by acute cholecystitis have common characteristics of poor-to-moderate functional capacity before fracture, increased blood glucose levels and enhanced protein metabolism after fracture. The death and the severe case have similar characteristics of low BMI, multiple underlying diseases, high plasma osmotic pressure and calculous cholecystitis, which occurred after orthopaedic surgery. These issues require attention and prompt, active intervention. Related issues require further research.
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Affiliation(s)
- Yuan Yuan
- Department of Geriatrics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Wei Tian
- Department of Geriatrics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Zhenzhen Jin
- Department of Ultrasound, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Shiwen Zhu
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.
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Flores-Calderón J, Cisneros-Garza LE, Chávez-Barrera JA, Vázquez-Frias R, Reynoso-Zarzosa FA, Martínez-Bejarano DL, Consuelo-Sánchez A, Reyes-Apodaca M, Zárate-Mondragón FE, Sánchez-Soto MP, Alcántara-García RI, González-Ortiz B, Ledesma-Ramírez S, Espinosa-Saavedra D, Cura-Esquivel IA, Macías-Flores J, Hinojosa-Lezama JM, Hernández-Chávez E, Zárate-Guerrero JR, Gómez-Navarro G, Bilbao-Chávez LP, Sosa-Arce M, Flores-Fong LE, Lona-Reyes JC, Estrada-Arce EV, Aguila-Cano R. Consensus on the management of complications of cirrhosis of the liver in pediatrics. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2022; 87:462-485. [PMID: 35810090 DOI: 10.1016/j.rgmxen.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/08/2022] [Indexed: 12/07/2022]
Abstract
The Asociación Mexicana de Hepatología A.C. carried out the Consensus on the Management of Complications of Cirrhosis of the Liver in Pediatrics to provide physicians with useful information for treating said complications. A group of pediatric gastroenterologists and experts in nutrition, nephrology, and infectious diseases participated and reviewed the medical literature. The Delphi method was applied to obtain the level of agreement on the statements that were formulated. The statements were sent to the participants to be analyzed and voted upon, after which they were discussed in virtual sessions, and the final versions were produced. The aim of the consensus results was to issue indications for the management of pediatric patients with liver cirrhosis, to prevent or control complications.
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Affiliation(s)
- J Flores-Calderón
- UMAE Hospital de Pediatría, CMN XXI Dr. Silvestre Frenk Freund IMSS, Cd, México, Mexico.
| | | | - J A Chávez-Barrera
- UMAE Hospital General CMN La Raza, Dr. Gaudencio González Garza IMSS, Cd, México, Mexico
| | | | | | | | | | | | | | - M P Sánchez-Soto
- Hospital de Especialidades del Niño y la mujer de Querétaro Dr. Felipe Núñez Lara, Querétaro, Mexico
| | | | - B González-Ortiz
- UMAE Hospital de Pediatría, CMN XXI Dr. Silvestre Frenk Freund IMSS, Cd, México, Mexico
| | - S Ledesma-Ramírez
- UMAE Hospital de Pediatría, CMN XXI Dr. Silvestre Frenk Freund IMSS, Cd, México, Mexico
| | - D Espinosa-Saavedra
- UMAE Hospital de Pediatría, CMN XXI Dr. Silvestre Frenk Freund IMSS, Cd, México, Mexico
| | | | - J Macías-Flores
- Hospital Infantil de Especialidades de Chihuahua, Chihuahua, Mexico
| | | | - E Hernández-Chávez
- UMAE Hospital de Pediatría Centro Médico de Occidente, IMSS, Guadalajara, Mexico
| | - J R Zárate-Guerrero
- UMAE Hospital de Pediatría Centro Médico de Occidente, IMSS, Guadalajara, Mexico
| | - G Gómez-Navarro
- UMAE Hospital de Pediatría Centro Médico de Occidente, IMSS, Guadalajara, Mexico
| | - L P Bilbao-Chávez
- UMAE Hospital General CMN La Raza, Dr. Gaudencio González Garza IMSS, Cd, México, Mexico
| | - M Sosa-Arce
- UMAE Hospital General CMN La Raza, Dr. Gaudencio González Garza IMSS, Cd, México, Mexico
| | - L E Flores-Fong
- Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Mexico
| | - J C Lona-Reyes
- Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Mexico
| | - E V Estrada-Arce
- Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Mexico
| | - R Aguila-Cano
- Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Mexico
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Sartan DI, Smirnov NL, Yelskyi IK. SONOGRAPHIC CRITERIA IN THE DIFFERENTIAL DIAGNOSIS OF OBSTRUCTIVE ICTERUS. SURGICAL PRACTICE 2022. [DOI: 10.38181/2223-2427-2022-2-67-74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The article presents the review of the literature data covering the most common causes of obstructive jaundice, methods for its differential diagnosis, as well as sonographic criteria for making a diagnosis. Based on the review, it was found that in practical surgery, ultrasound has a number of advantages in the differential diagnosis of obstructive jaundice. Sonography is an affordable, non-invasive method with high information content, allowing to make a diagnosis in the shortest possible time. The main reliable sonographic criteria for the obstructive genesis of icterus is prestenotic dilatation of the bile ducts. However, since the interpretation of ultrasound results is subjective and depends on the qualifications of the ultrasound specialist, verification of sonographic information by other research methods is necessary.
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Affiliation(s)
- D. I. Sartan
- State educational institution of higher professional education «M. Gorky Donetsk national medical university»
| | - N. L. Smirnov
- State educational institution of higher professional education «M. Gorky Donetsk national medical university»
| | - I. K. Yelskyi
- State educational institution of higher professional education «M. Gorky Donetsk national medical university»
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9
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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: 0] [Impact Index Per Article: 0] [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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10
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Katta T, Tavakoli K. Necrotizing Cholecystitis in the Gallbladder: A Case Report. Cureus 2022; 14:e21368. [PMID: 35070585 PMCID: PMC8764969 DOI: 10.7759/cureus.21368] [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] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
Infections caused by Candida species have shown a considerable increase in frequency in the recent past, and hence they are a cause of significant concern among medical practitioners. There are many factors that contribute to the occurrence of Candida-related infections in particular groups of patients. In this report, we present a case that highlights the causes and appropriate treatment methods of the condition. Patients with acute necrotizing cholecystitis often show poor outcomes after treatment, and hence physicians need to be alert when dealing with patients with this condition and should provide the best treatment method. We report a case of necrotizing cholecystitis in a 55-year-old female with a medical history of cholelithiasis, obesity, seizures, cocaine abuse, and anemia. She also reported lower abdominal pain, felt bloated, and complained of headache, dizziness, lack of appetite, shortness of breath, and vomiting. The patient underwent several lab tests as well as a CT scan of the abdomen, hepatobiliary iminodiacetic acid (HIDA) scan, endoscopy, and cholecystectomy.
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11
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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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12
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Gong Y, Li J, Zhu D, Wang S, Xu Y, Li Y, Wang Y, Song Y, Liu W, Tian Y. Case Report: Near-Fatal Intestinal Hemorrhage and Acute Acalculous Cholecystitis due to Vi-Negative and Fluoroquinolone-Insensitive Salmonella enterica Serovar Typhi Infection: A Rare Entity. Front Med (Lausanne) 2021; 8:666643. [PMID: 34447758 PMCID: PMC8383206 DOI: 10.3389/fmed.2021.666643] [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: 02/10/2021] [Accepted: 07/14/2021] [Indexed: 11/13/2022] Open
Abstract
Typhoid fever is usually a mild clinical disease. Typhoid fever with massive intestinal hemorrhage is rare in the antibiotic era. Acute acalculous cholecystitis (AAC) is also rare in adults. Here, we describe the first adult case of typhoid fever with both complications due to Vi-negative and fluoroquinolone-insensitive Salmonella enterica serovar Typhi (S. Typhi) infection. We aim to alert physicians to this rare condition.
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Affiliation(s)
- Yuehua Gong
- Yantai Center for Disease Control and Prevention, Yantai, China
| | - Jianlin Li
- Department of Radiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Dongnan Zhu
- Yantai Center for Disease Control and Prevention, Yantai, China
| | - Songsong Wang
- Yantai Center for Disease Control and Prevention, Yantai, China
| | - Yingchun Xu
- Yantai Center for Disease Control and Prevention, Yantai, China
| | - Yan Li
- Yantai Center for Disease Control and Prevention, Yantai, China
| | - Yanqing Wang
- Yantai Center for Disease Control and Prevention, Yantai, China
| | - Yan Song
- Yantai Center for Disease Control and Prevention, Yantai, China
| | - Wenjuan Liu
- Yantai Center for Disease Control and Prevention, Yantai, China
| | - Yunlong Tian
- Yantai Center for Disease Control and Prevention, Yantai, China
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13
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Zhao Y, Zhang L, Xing F, Zhang R, Huang J. Synchronous Acute Acalculous Cholecystitis and Appendicitis Due to Salmonella Group D: A Rare Case Report From China and Review of the Literature. Front Med (Lausanne) 2020; 7:406. [PMID: 33015080 PMCID: PMC7461861 DOI: 10.3389/fmed.2020.00406] [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: 05/04/2020] [Accepted: 06/29/2020] [Indexed: 12/07/2022] Open
Abstract
Non-typhoidal Salmonella (NTS) disease is not common as typhoid fever but has become a global public health problem in recent decades. Acute acalculous cholecystitis (AAC) and appendicitis are rare complications of NTS infection, which are usually difficult to be diagnosed with atypical signs. Pathogenesis of NTS-induced AAC and NTS-induced appendicitis is still unclear. Ultrasound is the first choice for diagnosis of these two rare complications, computed tomography can assist in and next-generation sequencing (NGS), as a new technology in clinical medicine, also facilitates diagnosis. We described a case of simultaneous AAC and appendicitis due to NTS in an elderly male and further confirmed the diagnosis using NGS. As far as we know, this is the first Asian case of two complications occurring at the same time. Our aim is to alert physicians to pay attention to this rare condition.
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Affiliation(s)
- Yan Zhao
- Rheumatology Department, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China.,Microbiology Department, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
| | - Lijun Zhang
- Rheumatology Department, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
| | - Fanfan Xing
- Microbiology Department, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
| | - Ruiping Zhang
- Pathology Department, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
| | - Jinxian Huang
- Rheumatology Department, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
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14
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Elkbuli A, Sanchez C, Kinslow K, McKenney M, Boneva D. Uncommon Presentation of Severe Empyema of the Gallbladder: Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923040. [PMID: 32734934 PMCID: PMC7414827 DOI: 10.12659/ajcr.923040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Patient: Male, 60-year-old Final Diagnosis: Severe empyema of the gallbladder Symptoms: Abdominal and/or epigastric pain • fever Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Adel Elkbuli
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| | - Carol Sanchez
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| | - Kyle Kinslow
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Dessy Boneva
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
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15
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Langenohl R, Young S, Couperus K. Acute Acalculous Cholecystitis from Infection with Epstein-Barr Virus in a Previously Healthy Child: A Case Report. Clin Pract Cases Emerg Med 2020; 4:393-396. [PMID: 32926694 PMCID: PMC7434242 DOI: 10.5811/cpcem.2020.4.46301] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 04/30/2020] [Indexed: 12/14/2022] Open
Abstract
Background Acute cholecystitis is the acute inflammation of the gallbladder. In adults it is most frequently caused by a gallstone(s) obstructing outflow from the cystic duct, leading to gallbladder distention and edema with eventual development of biliary stasis and bacterial overgrowth, often requiring operative management. However, in children acalculous cholecystitis is more common and is often the result of an infectious process. Case Report Here we present a case of acute acalculous cholecystitis caused by infection with Epstein-Barr virus in an otherwise healthy three-year-old male. Conclusion Acalculous cholecystitis is an uncommon but potentially significant complication of Epstein-Barr virus infection in the pediatric population. Emergency providers should consider this diagnosis in any child being evaluated for EBV with the complaint of abdominal pain.
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Affiliation(s)
- Robert Langenohl
- Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington
| | - Scott Young
- Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington
| | - Kyle Couperus
- Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington
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16
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Acute Acalculous Cholecystitis Associated with Epstein-Barr Infection: A Case Report and Review of the Literature. Case Rep Med 2020; 2020:9029601. [PMID: 32047519 PMCID: PMC7003250 DOI: 10.1155/2020/9029601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 01/06/2020] [Indexed: 02/06/2023] Open
Abstract
The most common cause of acute cholecystitis (ACC) is cholelithiasis. Acute acalculous cholecystitis (AAC) is well documented in the literature related with critical illness, but viral causes such as cytomegalovirus (CMV) and Epstein-Barr virus (EBV) have also been reported. We present a rare manifestation of EBV infection, reporting a case of a 15-year-old female suffering from acute acalulous cholecystitis, and we review the relevant literature. Clinicians should be aware of this rare complication of EBV infection and properly exclude it in young patients with cholecystitis.
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17
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Chandra S, Friesen C, Attard TM. Trends in the epidemiology of pediatric acute and chronic cholecystitis-related admissions in the USA: a nationwide emergency department and inpatient sample study. J Investig Med 2019; 67:1155-1159. [DOI: 10.1136/jim-2018-000948] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2019] [Indexed: 12/15/2022]
Abstract
Acute and chronic cholecystitis can be related to gallstone disease, although in childhood acalculous cholecystitis may be the most frequent form. Chronic acalculous cholecystitis is a subtype of pediatric chronic abdominal pain. The overall incidence of cholecystitis in children appears to be increasing. Studies suggest a widely variable but predominant female, Caucasian and late adolescent preponderance to the affected population. The Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project (HCUP), a national emergency department, pediatric and adult inpatient admission coding-based database was accessed for the population-weighted demographic characteristics related to documented principal diagnoses (International Classification of Diseases, Ninth Revision, Clinical Modification) of acute and chronic cholecystitis; pediatric and adult age range 2006–2012 (emergency department), 1997–2012 (inpatient service). ED-derived data show pediatric admissions at the smallest age category (1%), averaging 3.7/100 000 persons; discharges were highest in the 15–17 age range. Inpatient admission was more likely in older (93% >10 years), female (F:M 3.7:1) children, and patients from lower median household income residences. Over the study period, there was a significant relative increase in males. Mean length of inpatient stay was 3.2 days, tended to be shorter in female and older patients; this pattern was reflected in the overall hospital charges which rose threefold over the study period (1997–2012). Our study establishes the gender distribution of cholecystitis-related diagnoses and as yet poorly understood admission discrepancies based on gender and socioeconomic status. Length of admission has overall decreased but costs have risen threefold over the study period.
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18
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Acute Acalculous Cholecystitis with Empyema due to Salmonellosis. Case Rep Gastrointest Med 2019; 2019:5185314. [PMID: 31183222 PMCID: PMC6515067 DOI: 10.1155/2019/5185314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 04/18/2019] [Indexed: 01/11/2023] Open
Abstract
Empyema of acalculous gallbladder in the setting of salmonellosis represents an extremely rare and life-threatening clinical condition in adults. In this unique case report, we deal with a previously healthy patient who developed acalculous cholecystitis and empyema due to infection by Salmonella. He underwent explorative laparotomy in emergency setting, and cholecystectomy was performed due to his toxic clinical condition. Empyema of gallbladder was revealed and cultures were collected. A combination of antibiotics (ciprofloxacin and metronidazole) was set, and the patient was discharged 8 days after the surgical operation in good condition. It has to be highlighted that acalculous cholecystitis is a rare entity, mostly at critically ill patients, and treatment options depend on clinical condition, risk factors, and etiology. To our knowledge, this is the first case report dealing with acalculous cholecystitis with empyema due to salmonellosis up to date. Although it is extremely rare, high index of suspicion is needed by the operating surgeon in order to avoid unfavorable outcomes.
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19
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Poddighe D, Sazonov V. Acute acalculous cholecystitis in children. World J Gastroenterol 2018; 24:4870-4879. [PMID: 30487697 PMCID: PMC6250923 DOI: 10.3748/wjg.v24.i43.4870] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/11/2018] [Accepted: 10/21/2018] [Indexed: 02/06/2023] Open
Abstract
Acute acalculous cholecystitis (AAC) is the inflammatory disease of the gallbladder in the absence of gallstones. AAC is estimated to represent at least 50% to 70% of all cases of acute cholecystitis during childhood. Although this pathology was originally described in critically ill or post-surgical patients, most pediatric cases have been observed during several infectious diseases. In addition to cases caused by bacterial and parasitic infections, most pediatric reports after 2000 described children developing AAC during viral illnesses (such as Epstein-Barr virus and hepatitis A virus infections). Moreover, some pediatric cases have been associated with several underlying chronic diseases and, in particular, with immune-mediated disorders. Here, we review the epidemiological aspects of pediatric AAC, and we discuss etiology, pathophysiology and clinical management, according to the cases reported in the medical literature.
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Affiliation(s)
- Dimitri Poddighe
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
| | - Vitaliy Sazonov
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
- Pediatric Intensive Care Unit, UMC National Research Center for Mother and Child Health, Astana 010000, Kazakhstan
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20
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Hashimoto M, Koide K, Arita M, Kawaguchi K, Tokunaga M, Mikuriya Y, Iwamoto T. Acute acalculous cholecystitis due to breast cancer metastasis to the cystic duct. Surg Case Rep 2016; 2:111. [PMID: 27730536 PMCID: PMC5059227 DOI: 10.1186/s40792-016-0239-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 10/05/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Acute acalculous cholecystitis (AAC) is a relatively rare disorder of the gallbladder. Breast cancer recurrence more than 10 years after curative surgery is also infrequent. CASE PRESENTATION Here, we report a case of a 59-year-old woman who presented with right flank pain. Her medical history included a lumpectomy for cancer of the left breast 12 years prior. Laboratory tests showed a severe inflammatory reaction and mild liver function abnormalities. Ultrasonography and computed tomography revealed an enlarged gallbladder and inflammation of the surrounding tissues; however, no gallstone was present. She was diagnosed with AAC. We performed an emergency laparoscopic cholecystectomy, and histopathological examination revealed a poorly differentiated adenocarcinoma in the cystic duct. Both metastatic and primary tumor cells were positive for estrogen and progesterone receptors on immunohistochemistry. The final pathological diagnosis was acute cholecystitis due to breast cancer metastasis to the cystic duct. CONCLUSION Although AAC secondary to metastatic breast cancer is rare, it should be included in the differential diagnosis for abdominal pain in patients with a previous history of breast cancer.
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Affiliation(s)
- Masakazu Hashimoto
- Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan.
| | - Kei Koide
- Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan
| | - Michinori Arita
- Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan
| | - Koji Kawaguchi
- Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan
| | - Masakazu Tokunaga
- Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan
| | - Yoshihiro Mikuriya
- Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan
| | - Toshiyuki Iwamoto
- Department of Pathology, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan
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21
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Abstract
Choledocholithiasis occurs in up to approximately 20% of patients with cholelithiasis. A majority of stones form in the gallbladder and then pass into the common bile duct, where they generate symptoms, due to biliary obstruction. Confirmatory diagnosis of choledocholithiasis is made with advanced imaging, including magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP). Treatment varies locally; however, ERCP with sphincterotomy is most commonly employed with a high degree of success. Difficult anatomy and difficult stone burden require advanced surgical, endoscopic, and percutaneous techniques to extract or expel biliary stones. Knowledge of these treatment strategies will optimize outcomes.
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Affiliation(s)
- Christopher Molvar
- Department of Radiology, Section of Vascular and Interventional Radiology, Loyola University Medical Center, Maywood, Illinois
| | - Bryan Glaenzer
- Department of Radiology, Section of Vascular and Interventional Radiology, Loyola University Medical Center, Maywood, Illinois
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22
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Yi DY, Chang EJ, Kim JY, Lee EH, Yang HR. Age, Predisposing Diseases, and Ultrasonographic Findings in Determining Clinical Outcome of Acute Acalculous Inflammatory Gallbladder Diseases in Children. J Korean Med Sci 2016; 31:1617-23. [PMID: 27550491 PMCID: PMC4999405 DOI: 10.3346/jkms.2016.31.10.1617] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 06/24/2016] [Indexed: 12/23/2022] Open
Abstract
We evaluated clinical factors such as age, gender, predisposing diseases and ultrasonographic findings that determine clinical outcome of acute acalculous inflammatory gallbladder diseases in children. The patients were divided into the four age groups. From March 2004 through February 2014, clinical data from 131 children diagnosed as acute acalculous inflammatory gallbladder disease by ultrasonography were retrospectively reviewed. Systemic infectious diseases were the most common etiology of acute inflammatory gallbladder disease in children and were identified in 50 patients (38.2%). Kawasaki disease was the most common predisposing disease (28 patients, 21.4%). The incidence was highest in infancy and lowest in adolescence. The age groups were associated with different predisposing diseases; noninfectious systemic disease was the most common etiology in infancy and early childhood, whereas systemic infectious disease was the most common in middle childhood and adolescence (P = 0.001). Gallbladder wall thickening was more commonly found in malignancy (100%) and systemic infection (94.0%) (P = 0.002), whereas gallbladder distension was more frequent in noninfectious systemic diseases (60%) (P = 0.000). Ascites seen on ultrasonography was associated with a worse clinical course compared with no ascites (77.9% vs. 37.7%, P = 0.030), and the duration of hospitalization was longer in patients with ascites (11.6 ± 10.7 vs. 8.0 ± 6.6 days, P = 0.020). In conclusion, consideration of age and predisposing disease in addition to ultrasonographic gallbladder findings in children suspected of acute acalculous inflammatory gallbladder disease might result in better outcomes.
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Affiliation(s)
- Dae Yong Yi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea
| | - Eun Jae Chang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Young Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Hye Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
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Avilés-Martínez KI. [Spondylocostal dysostosis and acute cholangitis in pediatrics emergency room]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2016; 73:256-267. [PMID: 29421389 DOI: 10.1016/j.bmhimx.2016.04.002] [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: 12/28/2015] [Revised: 04/02/2016] [Accepted: 04/06/2016] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Congenital malformations of the chest wall comprise a heterogeneous group of diseases denominated spondylocostal dysostosis. They have in common developmental abnormalities in the morphology of the structures of the chest and vertebrae with a broad characterization: from mild deformity without functional consequences to life-threatening injuries. We present the case of a girl with spondylocostal dysostosis and acute cholangitis. CLINICAL CASE A 13-month-old girl with severe malnutrition, history of hydrocephalus and myelomeningocele at birth was admitted in the emergency pediatric room with fever and progressive respiratory distress. Clinical assessment revealed ribs and vertebral malformations and acute cholangitis. CONCLUSIONS Complex rib abnormalities consist in deformities of the chest wall, which do not have a specific pattern and are extremely rare. When they are associated with myelomeningocele and hydrocephalus they may be considered as autosomal recessive inheritance spondylocostal dysostosis. The diagnosis is established by clinical assessment and X-rays. Spondylocostal dysostosis identification and complications related to their genetic and molecular causes are still a challenge for clinical pediatricians and the multidisciplinary medical team who treats these patients throughout lifetime.
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24
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Abstract
Ultrasonography (US) is a valuable imaging tool for evaluation of different clinical conditions in children, in general and abdominal conditions, in particular. The interest in US derives primarily from the lack of ionizing radiation exposure, low cost, portability, real-time imaging and Doppler capabilities. In addition, US application requires no preparation or sedation, making it particularly attractive in the pediatric population. Because of these advantages, US has been adopted as the primary imaging tool for evaluation of a number of pediatric abdominal conditions that would have involved the use of ionising radiation in the past, e.g., pyloric stenosis, intussusception and various renal and bladder abnormalities, to name a few. Certain limitations, however, are inherent to US including large body habitus, excessive bowel gas, postoperative state and the learning curve. In addition, pediatric US is particularly challenging as the children are frequently unable to co-operate for breath holding and many of them are crying during the scanning. In the present review, the authors discuss the various applications of US in the evaluation of pediatric abdomen.
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25
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Yi DY, Kim JY, Yang HR. Ultrasonographic Gallbladder Abnormality of Primary Epstein-Barr Virus Infection in Children and Its Influence on Clinical Outcome. Medicine (Baltimore) 2015; 94:e1120. [PMID: 26166109 PMCID: PMC4504559 DOI: 10.1097/md.0000000000001120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The incidence of pediatric acute inflammatory gallbladder (GB) disease without gallstone such as acute acalculous cholecystitis has increased with the development of improved diagnostic modalities. Although Epstein-Barr virus (EBV) infection is common in general population, only few cases of GB diseases caused by EBV infection have been reported. This study analyzed ultrasonographic characteristics of primary EBV infection in children and evaluated the influence of EBV-associated GB disease on clinical course and outcome of EBV infection.Between March 2004 and January 2013, 94 of 287 pediatric patients with EBV infection underwent abdominal ultrasonography (USG); clinical features, laboratory data, and USG findings were collected and analyzed retrospectively.Of 94 children, ultrasonographic thick GB wall was observed in 24 (25.3%). Platelet counts were lower in the thickened GB wall group than in the normal GB wall thickness group (P = 0.004). Direct bilirubin, alanine aminotransferase, and γ-glutamyl transferase levels were higher in the thickened GB wall group (P = 0.000, P = 0.041, and P = 0.001, respectively). The duration of hospitalization was longer in patients with thickened GB wall (P = 0.043).Radiologic findings of acute acalculous inflammatory GB disease such as thickened GB wall caused by primary EBV infection are more common than previously reported. Consideration of EBV infection in the differential diagnosis of children suspected with acute acalculous GB diseases may avoid unnecessary surgical intervention.
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Affiliation(s)
- Dae Yong Yi
- From Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea (DYY, HRY); Department of Pediatrics, Chung-Ang University Hospital, Seoul, Republic of Korea (DYY); Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea (JYK); and Seoul National University College of Medicine, Seoul, Republic of Korea (HRY)
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26
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Choo SK, Park HJ, Oh HK, Kang YK, Kim Y. Acute cholecystitis in elderly patients after hip fracture: Incidence and epidemiology. Geriatr Gerontol Int 2015; 16:380-3. [PMID: 25810136 DOI: 10.1111/ggi.12483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Suk Kyu Choo
- Department of Orthopaedic Surgery; Inje University Ilsan Paik Hospital; Goyang Korea
| | - Hyung Jun Park
- Department of Orthopaedic Surgery; Inje University Ilsan Paik Hospital; Goyang Korea
| | - Hyoung-Keun Oh
- Department of Orthopaedic Surgery; Inje University Ilsan Paik Hospital; Goyang Korea
| | - Yoo Kyung Kang
- Department of Orthopaedic Surgery; Inje University Ilsan Paik Hospital; Goyang Korea
| | - Youngwoo Kim
- Department of Orthopaedic Surgery; Inje University Ilsan Paik Hospital; Goyang Korea
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27
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Zhang L, Han Q, Zhang H, Li D, Yao K. Significance and clinical applications of ultrasound score in assessing the clinical severity of acute cholecystitis in the elderly. Aging Clin Exp Res 2015; 27:21-6. [PMID: 24821600 DOI: 10.1007/s40520-014-0236-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 04/18/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To investigate the feasibility and significance of the clinical application of ultrasound score in assessing the clinical severity of acute cholecystitis in the elderly. METHODS Pre-surgery ultrasonography was performed on 72 elderly patients with acute cholecystitis who were scheduled for cholecystectomy to determine the score based on ultrasonic imaging features to reflect clinical severity. Prior to operation, the cases were classified as mild, moderate, and severe according to clinical manifestation. The significance of ultrasonography for the prediction of the severity of acute cholecystitis and its pre-surgery guidance were evaluated based on intraoperative findings and postoperative pathology. RESULT In the aspect of clinical severity, of the 72 cases, 36 were mild, 21 were moderate, and 15 were severe. The cases that showed enlarged gallbladders, thickened gallbladder walls, double-layer images, gallbladder stones, incarcerated gall-stones, echoes in gallbladder fluid, peri-gallbladder effusions, or adherences were mostly moderate and severe cases. The difference in these cases with the mild cases exhibited statistical significance (P < 0.05). Of the 28 cases that scored ≤5, 26 (92.68 %) were mild cases. The 26 cases that scored between 6 and 9 mainly consisted of 15 moderate cases (57.7 %). The 18 cases that scored ≥10 mainly consisted of 13 severe cases (72.2 %). Significant differences were found in the cholecystostomy cases among the three groups (P < 0.05). CONCLUSION Prior to cholecystectomy, ultrasound score could accurately determine the severity of acute cholecystitis in the elderly and may be used as a reference for surgical intervention timing and mode selection to guide clinical therapy.
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Affiliation(s)
- Longfang Zhang
- Department of Ultrasound Diagnostics, General Hospital of Chinese PLA Air Force, Beijing, 100142, China
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Peitzman AB, Watson GA, Marsh JW. Acute cholecystitis: When to operate and how to do it safely. J Trauma Acute Care Surg 2015; 78:1-12. [PMID: 25539197 DOI: 10.1097/ta.0000000000000476] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Andrew B Peitzman
- From the Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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Yi DY, Kim JY, Choi EY, Choi JY, Yang HR. Hepatobiliary risk factors for clinical outcome of Kawasaki disease in children. BMC Pediatr 2014; 14:51. [PMID: 24548331 PMCID: PMC3938642 DOI: 10.1186/1471-2431-14-51] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 02/13/2014] [Indexed: 12/20/2022] Open
Abstract
Background Kawasaki disease (KD) is an acute febrile vasculitis that causes coronary artery abnormality (CAA) as a complication. In some patients, an association has been noted between elevated liver enzymes or an abnormal gallbladder (GB) and hepatobiliary involvement in KD. In this study, we aimed to evaluate clinical, laboratory, and ultrasonographic (USG) risk factors of hepatobiliary involvement for the intravenous immunoglobulin (IVIG) resistance and the development of CAA in children with KD. Methods From March 2004 through January 2013, clinical features, laboratory data, echocardiographic findings, and USG findings were retrospectively reviewed regarding the response to IVIG treatment and coronary artery complications in 67 children with KD. Acute acalculous cholecystitis (AAC) was diagnosed based on USG criteria. Results Among all factors, only the prothrombin time international normalized ratio was significantly different between the IVIG-response and IVIG-resistance groups (p = 0.024). CAA was statistically more frequent in the AAC group (n = 24) than in the non-AAC group (n = 43) (23.3% vs. 58.3%, p = 0.019). Among the laboratory factors, segmented neutrophil percentage, total bilirubin level, and C-reactive protein were significant in children with CAA (p = 0.014, p = 0.009, and p = 0.010). Abnormal GB findings on USG were significantly more frequent in children with CAA than in those without CAA (p = 0.007; OR = 4.620; 95% confidence interval [CI]: 1.574–13.558). GB distension on USG was the only significant risk factor for CAA (p = 0.001; OR = 7.288; 95% CI: 2.243–23.681) by using multiple logistic regression analysis. Conclusion For children in the acute phase of KD, USG findings of the GB, especially GB distension, may be an important risk factor for CAA as a complication.
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Affiliation(s)
| | | | | | | | - Hye Ran Yang
- Department of Pediatrics, Division of Pediatric Gastroenterology and Hepatology, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
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Changes in the therapeutic strategy for acute cholecystitis after the Tokyo guidelines were published. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 20:348-55. [PMID: 22869101 DOI: 10.1007/s00534-012-0536-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND This study examined the feasibility of early laparoscopic cholecystectomy (ELC) for acute cholecystitis (AC) according to the Tokyo guidelines severity grade, and analyzed the changes in the therapeutic strategy for AC after the Tokyo guidelines were published. METHODS A total of 225 patients were enrolled in this study. The therapeutic period was divided into two periods: before and after the publication of the Tokyo guidelines (prior to and including 2007, and from 2008, respectively). RESULTS Comparing the surgical strategy between ELC and delayed laparoscopic cholecystectomy (DLC), significant differences were found in the length of preoperative hospital stay and total hospital stay for cases of mild AC compared with moderate AC. With conversion to open surgery, postoperative complications including postoperative bile leak were not significantly different. Since ELC was performed significantly more often after publication of the guidelines, preoperative, postoperative, and total hospital stays were significantly shorter in the later period. CONCLUSION ELC is a safe and effective therapeutic strategy for both mild and moderate AC. The Tokyo guidelines resulted in a significant increase in the performance of ELC and significantly reduced preoperative and total hospital stays without increasing intra- and postoperative complications.
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Higuchi R, Takada T, Strasberg SM, Pitt HA, Gouma DJ, Garden OJ, Büchler MW, Windsor JA, Mayumi T, Yoshida M, Miura F, Kimura Y, Okamoto K, Gabata T, Hata J, Gomi H, Supe AN, Jagannath P, Singh H, Kim MH, Hilvano SC, Ker CG, Kim SW. TG13 miscellaneous etiology of cholangitis and cholecystitis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 20:97-105. [PMID: 23307005 DOI: 10.1007/s00534-012-0565-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This paper describes typical diseases and morbidities classified in the category of miscellaneous etiology of cholangitis and cholecystitis. The paper also comments on the evidence presented in the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG 07) published in 2007 and the evidence reported subsequently, as well as miscellaneous etiology that has not so far been touched on. (1) Oriental cholangitis is the type of cholangitis that occurs following intrahepatic stones and is frequently referred to as an endemic disease in Southeast Asian regions. The characteristics and diagnosis of oriental cholangitis are also commented on. (2) TG 07 recommended percutaneous transhepatic biliary drainage in patients with cholestasis (many of the patients have obstructive jaundice or acute cholangitis and present clinical signs due to hilar biliary stenosis or obstruction). However, the usefulness of endoscopic naso-biliary drainage has increased along with the spread of endoscopic biliary drainage procedures. (3) As for biliary tract infections in patients who underwent biliary tract surgery, the incidence rate of cholangitis after reconstruction of the biliary tract and liver transplantation is presented. (4) As for primary sclerosing cholangitis, the frequency, age of predilection and the rate of combination of inflammatory enteropathy and biliary tract cancer are presented. (5) In the case of acalculous cholecystitis, the frequency of occurrence, causative factors and complications as well as the frequency of gangrenous cholecystitis, gallbladder perforation and diagnostic accuracy are included in the updated Tokyo Guidelines 2013 (TG13). Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.
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Affiliation(s)
- Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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Murata A, Okamoto K, Matsuda S, Kuwabara K, Ichimiya Y, Matsuda Y, Kubo T, Fujino Y, Fujimori K, Horiguchi H. The care processes for acute cholecystitis according to clinical practice guidelines based on the Japanese administrative database. TOHOKU J EXP MED 2013; 227:237-44. [PMID: 22820613 DOI: 10.1620/tjem.227.237] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Acute cholecystitis is one of the most frequently encountered conditions in daily practice in Japan. However, there is a shortage of detailed data about treatments that have been performed according to the clinical practice guidelines (CPGs) for acute cholecystitis. We therefore examined the management of acute cholecystitis for adherence to the appropriate CPGs using the Japanese administrative database associated with the Diagnosis Procedure Combination (DPC) system. We collected data from 6,070 patients with acute cholecystitis, examining for the application of four recommended treatments (administration of antimicrobial drugs and nonsteroidal anti-inflammatory drugs (NSAIDs) and performance of early and laparoscopic cholecystectomy). The patients were classified according to the procedures documented for each case: no gallbladder drainage (n = 4,333), gallbladder drainage without supportive care (ventilation or hemodiafiltration or the use of vasopressor) (n = 1,591) and gallbladder drainage and supportive care (n = 146). Multiple logistic regression models revealed that patients with gallbladder drainage without supportive care and those with gallbladder drainage and supportive care significantly higher received administration of antimicrobial drugs and NSAIDs, while these patients underwent less early or laparoscopic cholecystectomy than did patients without gallbladder drainage, after adjusting for potential confounding effects of the clinical variables. This study demonstrated that there were various differences with regard to the performance of recommended treatments between the levels of procedures required for acute cholecystitis. In addition, this administrative database was a feasible tool for the evaluation of care processes and will provide useful information contributing to improved quality of medical care.
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Affiliation(s)
- Atsuhiko Murata
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyusyu, Japan.
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Murata A, Matsuda S, Kuwabara K, Ichimiya Y, Matsuda Y, Kubo T, Fujino Y, Fujimori K, Horiguchi H. Association between hospital volume and outcomes of elderly and non-elderly patients with acute biliary diseases: a national administrative database analysis. Geriatr Gerontol Int 2012; 13:731-40. [PMID: 22985177 DOI: 10.1111/j.1447-0594.2012.00938.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIM This study aimed to investigate the relationship between hospital volume and clinical outcomes of elderly and non-elderly patients with acute biliary diseases using data from a national administrative database. METHODS Overall, 26720 elderly and 33774 non-elderly patients with acute biliary diseases were referred to 820 hospitals in Japan. Hospital volume was categorized into three groups based on the case numbers during the study period: low-volume, medium-volume and high-volume. We compared the risk-adjusted length of stay (LOS) and in-hospital mortality in relation to hospital volume. These analyses were stratified according to the presence of invasive treatments for acute biliary diseases. RESULTS Multiple linear regression analyses showed that increased hospital volume was significantly associated with shorter LOS in both elderly and non-elderly patients with and without invasive treatments. Increased hospital volume was significantly associated with decreased relative risk of in-hospital mortality in elderly patients. The odds ratio for high-volume hospitals was 0.672 in elderly patients without invasive treatments (95% confidence interval [CI] 0.533-0.847, P=0.001) and 0.715 in those with invasive treatments (95% C, 0.566-0.904, P=0.005). However, no significant differences for in-hospital mortality were seen in non-elderly patients with and without invasive treatments. CONCLUSION This study has highlighted that higher volume hospitals significantly reduced LOS and in-hospital mortality for elderly patients with acute biliary diseases, but not non-elderly patients. The current results are of value for elderly healthcare policy decision-making, and highlight the need for further studies into the quality of care for elderly patients.
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Affiliation(s)
- Atsuhiko Murata
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
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Bacteriological analysis of bile in acute cholecystitis according to the Tokyo guidelines. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2011; 19:476-86. [DOI: 10.1007/s00534-011-0463-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Evaluation of compliance with the Tokyo Guidelines for the management of acute cholangitis based on the Japanese administrative database associated with the Diagnosis Procedure Combination system. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2011; 18:53-9. [PMID: 20607569 DOI: 10.1007/s00534-010-0302-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND/PURPOSE We aimed to evaluate compliance with the clinical practice guidelines for acute cholangitis (Tokyo Guidelines) using the Japanese administrative database associated with the Diagnosis Procedure Combination (DPC) system. METHODS We collected database data from 60,842 acute cholangitis patients, examining 10 recommendations in the Tokyo Guidelines. We counted how many recommendations had been complied with for every patient. The patient compliance score was defined as the rate of compliance with these recommendations (score 0 = 0% to score 10 = 100%). An aggregated patient compliance score was measured according to the severity of acute cholangitis. Severity was categorized as grade I (mild cholangitis; n = 49,630), grade II (moderate cholangitis; n = 10,444), and grade III (severe cholangitis; n = 768). RESULTS The mean patient compliance score was significantly higher for patients with grade III than for those with grades II and I (7.6 ± 2.1 vs. 6.5 ± 3.0 vs. 2.9 ± 0.9, p < 0.001, respectively). Multiple linear regression analysis revealed that the severity of acute cholangitis was the parameter most significantly associated with the patient compliance score. The standardized coefficient of grade III was higher than that of grade II (0.657 vs. 0.248, p < 0.001). CONCLUSIONS Compliance with the Tokyo Guidelines became higher in accordance with the severity of acute cholangitis.
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An Observational Study Using a National Administrative Database to Determine the Impact of Hospital Volume on Compliance With Clinical Practice Guidelines. Med Care 2011; 49:313-20. [PMID: 21263358 DOI: 10.1097/mlr.0b013e3182028954] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Nievelstein RAJ, Robben SGF, Blickman JG. Hepatobiliary and pancreatic imaging in children-techniques and an overview of non-neoplastic disease entities. Pediatr Radiol 2011; 41:55-75. [PMID: 20967540 PMCID: PMC3016234 DOI: 10.1007/s00247-010-1858-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 08/10/2010] [Accepted: 08/30/2010] [Indexed: 02/07/2023]
Abstract
Imaging plays a major role in the diagnostic work-up of children with hepatobiliary or pancreatic diseases. It consists mainly of US, CT and MRI, with US and MRI being the preferred imaging modalities because of the lack of ionizing radiation. In this review the technique of US, CT and MRI in children will be addressed, followed by a comprehensive overview of the imaging characteristics of several hepatobiliary and pancreatic disease entities most common in the paediatric age group.
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Affiliation(s)
- Rutger A. J. Nievelstein
- Department of Radiology E01.132, University Medical Center Utrecht, Wilhelmina Children’s Hospital, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Simon G. F. Robben
- Department of Radiology, University Medical Center Maastricht, Maastricht, The Netherlands
| | - Johan G. Blickman
- Department of Imaging Sciences, Golisano Children’s Hospital, Rochester, NY USA
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Kitamura E, Ogino M. Occurrence of cholelithiasis and cholecystitis in amyotrophic lateral sclerosis patients with long-term tracheostomy invasive ventilation. Intern Med 2011; 50:2291-5. [PMID: 22001453 DOI: 10.2169/internalmedicine.50.5663] [Citation(s) in RCA: 4] [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] Open
Abstract
OBJECTIVE We clarified the prevalence of cholelithiasis/cholecystitis in long-term tracheostomy invasive ventilation (TIV) patients in our hospital. METHODS We investigated the occurrence of cholelithiasis/cholecystitis in twenty-seven TIV patients over the past eight years. RESULTS There were ten patients with cholelithiasis/cholecystitis. The underlying disease was amyotrophic lateral sclerosis (ALS), except for 1 patient. Mean age was 56.2 ± 4.7 years and the average period to the attack of cholelithiasis/cholecystitis from TIV was 57.6 ± 15.1 months. Two patients of acute cholecystitis had acalculous cholecystitis. Five of the ten patients developed a severe state of cholecystitis and needed aggressive therapy. CONCLUSION The prevalence of gallstones, symptom prevalence of asymptomatic cholelithiasis, the percentage of acalculous cholecystitis of acute cholecystitis in TIV patients was higher than in the general population. Therefore, it may be possible that TIV is a risk for cholelithiasis/cholecystitis. Some of the ALS patients with long-term TIV develop severe cholelithiasis/cholecystitis, and those facts should be considered in our daily clinical practice.
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Affiliation(s)
- Eiji Kitamura
- Department of Neurology, Kitasato University School of Medicine, Japan.
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Murata A, Matsuda S, Kuwabara K, Fujino Y, Kubo T, Fujimori K, Horiguchi H. Impact of hospital volume on clinical outcomes of endoscopic biliary drainage for acute cholangitis based on the Japanese administrative database associated with the diagnosis procedure combination system. J Gastroenterol 2010; 45:1090-6. [PMID: 20502923 DOI: 10.1007/s00535-010-0257-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 05/01/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND We aimed to determine the relationship between hospital volume and the clinical outcomes of endoscopic biliary drainage for acute cholangitis, using the Japanese administrative database associated with the diagnosis procedure combination (DPC) system. METHODS A total of 8698 patients with endoscopic biliary drainage were referred to 654 hospitals. We corrected patients' data from the database to compare risk-adjusted length of stay (LOS) and drainage-related complications in relation to the hospital volume. Hospital volume was categorized into three groups based on number of cases during the study period: low-volume hospitals (LVHs; <16 cases), medium-volume hospitals (MVHs; 16-32 cases), and high-volume hospitals (HVHs; >32 cases). RESULTS Significant variation in mean LOS was observed between hospital volume categories (26.8 ± 22.6 days in LVHs vs. 23.3 ± 21.5 days in MVHs vs. 19.7 ± 17.2 days in HVHs, P < 0.001). There was a significant difference with regard to complications of endoscopic biliary drainage (5.6% in LVHs vs. 4.3% in MVHs vs. 3.2% in HVHs, P < 0.001). Multiple linear regression analysis revealed that hospital volume was most significantly associated with a decrease in risk-adjusted LOS. The standardized coefficient of MVHs was -0.155, whereas that of HVHs was -0.802. Multiple logistic regression analysis showed that hospital volume decreased the relative risk of drainage-related complications. The odds ratio (OR) of MVHs was 0.764 [95% confidence interval (CI), 0.604-0.965], whereas the OR of HVHs was 0.561 (95% CI, 0.434-0.725). CONCLUSIONS There was a significant association between hospital volume and the clinical outcomes of endoscopic biliary drainage for acute cholangitis.
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Affiliation(s)
- Atsuhiko Murata
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Japan.
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Huffman JL, Schenker S. Acute acalculous cholecystitis: a review. Clin Gastroenterol Hepatol 2010; 8:15-22. [PMID: 19747982 DOI: 10.1016/j.cgh.2009.08.034] [Citation(s) in RCA: 164] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 08/14/2009] [Accepted: 08/19/2009] [Indexed: 02/07/2023]
Abstract
Although recognized for more than 150 years, acute acalculous cholecystitis (AAC) remains an elusive diagnosis. This is likely because of the complex clinical setting in which this entity develops, the lack of large prospective controlled trials that evaluate various diagnostic modalities, and thus dependence on a small data base for clinical decision making. AAC most often occurs in critically ill patients, especially related to trauma, surgery, shock, burns, sepsis, total parenteral nutrition, and/or prolonged fasting. Clinically, AAC is difficult to diagnose because the findings of right upper-quadrant pain, fever, leukocytosis, and abnormal liver tests are not specific. AAC is associated with a high mortality, but early diagnosis and intervention can change this. Early diagnosis is the crux of debate surrounding AAC, and it usually rests with imaging modalities. There are no specific criteria to diagnose AAC. Therefore, this review discusses the imaging methods most likely to arrive at an early and accurate diagnosis despite the complexities of the radiologic modalities. A pragmatic approach is vital. A timely diagnosis will depend on a high index of suspicion in the appropriate patient, and the combined results of clinical findings (admittedly nonspecific), plus properly interpreted imaging. Sonogram (often sequential) and hepatic iminodiacetic acid scans are the most reliable modalities for diagnosis. It is generally agreed that cholecystectomy is the definitive therapy for AAC. However, at times a diagnostic/therapeutic drainage via interventional radiology/surgery may be necessary and life-saving, and may be the only treatment needed.
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Affiliation(s)
- Jason L Huffman
- Department of Internal Medicine, Division of Gastroenterology and Nutrition, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
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Fujita T, Kojima M, Gotohda N, Takahashi S, Nakagohri T, Konishi M, Ochiai A, Kinoshita T. Incidence, clinical presentation and pathological features of benign sclerosing cholangitis of unknown origin masquerading as biliary carcinoma. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2009; 17:139-46. [PMID: 19399359 DOI: 10.1007/s00534-009-0115-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/25/2009] [Accepted: 03/10/2009] [Indexed: 12/31/2022]
Abstract
BACKGROUND Benign obstructions of the liver hilum are occasionally encountered in surgically resected cases. Some of these cases are pathologically classified as benign sclerosing cholangitis and are not clearly categorized. This study aims to elucidate the clinicopathological features of benign sclerosing cholangitis of unknown origin. METHODS Patients who had undergone surgery of the proximal bile duct from 1993 to 2008 on suspicion of proximal bile carcinoma were evaluated, then their clinical presentation, histopathological and immunohistochemical findings were retrospectively analyzed. RESULTS One hundred seventy-six patients underwent surgery during this period. Of these, five patients were diagnosed with benign sclerosing cholangitis of unknown origin. All five patients were middle-aged with no history of autoimmune disease. One patient died of recurrent cholangitis after surgery. Histopathologically, lymphoplasmacytic infiltrations were observed in all five cases. Among them, the clinicopathological findings of one patient were compatible with IgG4-related sclerosing cholangitis, and the other two patients had unusual histopathological findings with prominent lymph follicular formation. CONCLUSIONS Although patients with benign sclerosing cholangitis of unknown origin comprise a heterogeneous population, they can be further classified into subgroups. The response to immunosuppressive therapy, long-term prognosis and histological morphology of the disease should be considered in order to classify these cases of sclerosing cholangitis.
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Affiliation(s)
- Takeo Fujita
- Division of Digestive Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan.
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Mann CD, Metcalfe MS, Neal CP, Robertson GS. Delayed necrotizing acalculous cholecystitis after multiple trauma. Am J Emerg Med 2008; 26:631.e1-2. [PMID: 18534305 DOI: 10.1016/j.ajem.2007.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Accepted: 09/19/2007] [Indexed: 11/17/2022] Open
Abstract
This is a case report of a necrotizing acalculous cholecystitis 7 weeks after multiple orthopedic trauma successfully treated by operative intervention.
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Affiliation(s)
- Christopher D Mann
- Department of Surgery, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester LE1 5WW, UK.
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