<b> Aim: </b> The study was conducted to analyse the recent peer-reviewed literature related to symptomatic spilled gallstones after Laparoscopic Cholecystectomy (LC). </br></br> <b>Materials and methods:</b> Articles published in the peer-reviewed journals of repute from 2012–2022 were evaluated for nine variables including: [I] age of the patient, [II] gender, [III] interval since index LC, [IV] index LC if emergent/difficult or elective/straightforward, [V] clinical presentation, [VI] spilled gallstones if detected by imaging, [VII] management, [VIII] approach to management, [IX] number of spilled gallstones. </br></br> <b>Results:</b> There were a total of 71 cases (37 males and 34 females) with a mean age of 63.7 years. The time of onset of symptoms from spilled gallstones, after index LC, ranged from 2 days to 15 years and 57 patients (80.3%) presented within 6 years. Forty (56.3%) patients were unaware of the fact that gallstone spillage had occurred during index LC. The retained gallstones were detected by imaging in 47 (66.1%) cases and they were multiple in 51 (71.8%). In 52 patients (73.2%), the stones manifested as abdominal abscess/foreign body granuloma; the other presentations being pelvic pain/fistula, intestinal obstruction, abdominal lump simulating malignancy, incidental finding of metastatic lesions and generalized peritonitis. The major approaches adopted to retrieve the retained stones included open surgery, laparoscopy and percutaneous drainage. There were two deaths (2.9%) due to spilled gallstones. </br></br> <b>Conclusion:</b> Retained gallstones represent a complication of laparoscopic cholecystectomy (LC) that has a potential to create morbidity and diagnostic difficulties, even after a substantial delay. There is a need to spread awareness about the adverse effects of spilled stones so that they are actively looked for and retrieved if gallbladder perforates during cholecystectomy. Whenever such a complication occurs, the patient should be properly informed and the details should be very clearly mentioned in the operation notes.
Cholelithiasis is very common, affecting around 10-15% of the general population, but giant gallstones measuring 5 cm or more are very rare with only a few cases reported in the literature. Laparoscopic cholecystectomy (LC) is very difficult in such cases, especially in emergency situations, but can be safely performed by skilled surgeons. One such 47-year-old male with a giant gallstone measuring 8.7 cm x 4.2 cm x 3.4 cm was safely managed by laparoscopic approach and is presented due to its rarity.
Tubular adenomas of the breast are rare benign epithelial neoplasms and not many cases have been reported. Predominantly, the tumor is described as a palpable, well-circumscribed mass. Most often confused with fibroadenomas clinically and radiologically. Surgical excision is mandatory for diagnosis and to prevent the growth of the mass. Here, we presented a case of these rare tumors. Our case describes a large mass measuring 4.5 × 2.0 × 3.7 cm with tubular adenoma pathology. We elected to document this case to aid in the management of this rare neoplasm. Our aim is to allow physicians to get better identification and treatment for such tumors and improve the outcome for the patients.
Breast cancer can metastasize to a wide range of organs, but reports about uterine metastases are rare. The current article systematically analyzes 55 patients reported in peer-reviewed literature from 2010–2022 with respect to nine variables, including: [i] age of the patient; [ii] clinical presentation of uterine metastasis; [iii] precise location of metastasis; [iv] primary (breast) cancer histopathology; [v] imaging modality utilized for detection of metastasis; [vi] timing of appearance of metastases: synchronous or metachronous; [vii] immunochemistry markers; [viii] management; and [ix] survival. Uterine metastases may appear in synchronous or metachronous fashion and may be asymptomatic or have symptoms like abnormal vaginal bleeding. Treatment of uterine metastases usually comprises of total abdominal hysterectomy with bilateral salpingo-oophorectomy along with chemotherapy. The long-term prognosis is unclear, but due to the development of metastases in other bodily parts, cases frequently have a poor outcome.
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