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Alimentary Tract Diseases
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Ryan Lamm, Arturo J. Rios-Diaz, Priyadarshini Koduri, Francesco Palazzo
Acute cholecystitis is inflammation of the gallbladder. A diagnosis of acute cholecystitis should be made on the basis of characteristic history and physical examination. The 2018 Tokyo Guidelines diagnostic criteria can be followed to make a diagnosis of acute cholecystitis (Table 12.2) [21]. Murphy's sign is a physical examination finding of increased abdominal rigidity on inspiration and right upper quadrant tenderness. This sign can also be elicited on a right upper quadrant ultrasound examination with visualization of the gallbladder being compressed. This sign is pathognomonic for acute cholecystitis, but may not always be present on exam, depending on gestational age and body habitus.
Acute Cholecystitis
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Takanori Morikawa, Michiaki Unno
Most of the patients with acute cholecystitis present with right-upper quadrant abdominal pain lasting several hours, with or without pyrexia. They may have varying degrees of nausea, anorexia, jaundice, and abdominal pain with radiation to the right shoulder or interscapular area. On clinical examination, right-upper quadrant tenderness with arrest of respiration by deep palpation at the tip of the ninth costal cartilage at the height of inspiration (Murphy’s sign) is a pathognomonic sign. As the disease process advances with local adhesions, a right-upper quadrant mass may be palpable. In general, diagnosis of acute cholecystitis is determined using the combination of clinical symptoms, blood tests, and radiological findings. In addition, it is very important to confirm the duration from the onset of the symptoms to the first visit because that is needed to determine the therapeutic strategy.
Gastrointestinal cancer
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Choledochojejunostomy will relieve obstructive jaundice in cases not amenable to endoscopic or percutaneous stenting. Cholecystectomy should be considered to prevent the possibility of an acute cholecystitis.
Clinical outcomes and predictors of technical failure of endoscopic transpapillary gallbladder drainage in acute cholecystitis
Published in Scandinavian Journal of Gastroenterology, 2023
Junya Sato, Kazunari Nakahara, Yosuke Michikawa, Ryo Morita, Keigo Suetani, Akihiro Sekine, Yosuke Igarashi, Shinjiro Kobayashi, Takehito Otsubo, Fumio Itoh
Between January 2011 and December 2019, 249 consecutive patients underwent ETGBD for acute cholecystitis. Among them, seven were excluded because they underwent endoscopic transpapillary gallbladder aspiration without stent or drainage catheter placement. A total of 242 patients were enrolled in this study (Figure 1). The most common cystic duct directions and locations were the proximal branches in 187 patients, right branches in 169, and cranial branches in 231 (Table 1). Gallstones (83%) were the most common cause of cholecystitis. The stones were located in the cystic duct in 26 patients (11%) and gall bladder neck in 40 (17%). Mild cholecystitis was diagnosed in approximately half of the patients, moderate in 83 (34%), and severe in 40 (17%). In this study, 106 patients were administered antithrombotic agents including aspirin, cilostazol, ticlopidine, clopidogrel, prasugrel, sarpogrelate, icosapentate, warfarin, dabigatran, apixaban, and edoxaban.
Regional variations in Sweden over time regarding the surgical treatment of acute cholecystitis: a population-based register study
Published in Scandinavian Journal of Gastroenterology, 2022
Jakob Holmberg Larsson, Johanna Österberg, Gabriel Sandblom, Lars Enochsson
Acute cholecystitis is caused by an obstruction of the gallbladder neck or the cystic duct, in most cases due to gallstones, leading to distension and an ensuing bacterial or chemical inflammation of the gallbladder. If left untreated, it can cause perforations, fistulae, abscess formation or chronic cholecystitis. In the early stages of acute cholecystitis, the gallbladder is surrounded by oedema, making it easier to identify the different tissue layers, resulting in generally less complicated surgery [3,4]. If surgery is delayed, the local inflammation causes a gradual replacement of the oedema with regenerative tissue, which makes it more problematic to identify the tissue layers and the surgical dissection thus more challenging. According to the WSES updated guidelines [5] as well as the 2018 Tokyo guidelines [6], early laparoscopic cholecystectomy is the standard of care for patients with acute calculous cholecystitis.
Occlusion of the cystic duct with cyanoacrylate glue at laparoscopic subtotal fenestrating cholecystectomy for a difficult gallbladder
Published in Acta Chirurgica Belgica, 2022
Deborah C. Jenner, Michail Klimovskij, Michael Nicholls, Tom Bates
The place of laparoscopic subtotal cholecystectomy in the face of severe inflammatory disease without conversion to an open operation is well recognised [22,23] and has recently been described as a fenestrating or reconstituting procedure [14]. The technique of reconstituting, in which a small part of the remaining gallbladder wall is closed to facilitate the closure of a difficult duct creates a remnant gallbladder. This leads to a higher reoperation rate for recurrent cholecystitis in the long term, as shown in the special review by Strasberg et al. [14]. When the surgeon is unable to identify the cystic duct securely by the critical view of safety, fenestrating cholecystectomy, where the posterior wall of the gallbladder is left open without reconstitution, is the preferred option. A laparoscopic procedure is advantageous in the hands of an experienced laparoscopic surgeon, as here where the first author was the sole surgeon. Biliary fistula is more frequent with the fenestrating technique where the duct is left open and drained but in the present series this has been reduced by the safe application of glue to the duct orifice.