Beyond acute cholecystitis—gallstone-related complications and what the emergency radiologist should know

Tran, Andrew; Hoff, Carrie N.; Polireddy, Karunesh; Neymotin, Arie; Maddu, Kiran

doi:10.1007/s10140-021-01999-y

Cited by 8 publications

(6 citation statements)

References 70 publications

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“…As per the findings of Reddy et al (14) , the presence of cholelithiasis poses a challenge in identifying the choledochus, thereby elevating the likelihood of harm. The occlusion of the common bile duct by gallstones may be attributed to a potential reduction in its visibility, as suggested by Tran et al (15) . Research findings indicate that the presence of gallstones may potentially result in the development of cholecystitis and pericholecystic inflammation.…”

Section: Discussionmentioning

confidence: 87%

Predective Factors of Common Bile Duct Injury in Laparoscopic Cholecystectomy

2024

The Egyptian Journal of Hospital Medicine

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Background: Laparoscopic cholecystectomy (LC) has become the preferred treatment for symptomatic gallstone disease, but advanced age and comorbidities increase the risk of complications. The incidence of bile duct injuries during LC has also increased, with various technical factors contributing to higher rates. Aim: This study aimed to evaluate the prevalence and predictive factors of common bile duct (CBD) injury in laparoscopic cholecystectomy. Patients and Methods: 850 patients with high-risk chronic diseases and specific gallbladder conditions were prospectively observed. Patients with symptomatic cholecystitis, gallstones, gallbladder polypoid lesions, and cirrhotic patients were included. Exclusion criteria involved certain conditions and contraindications. LC was performed using standard techniques, and peri-operative management followed local protocols. Results: The study included predominantly female participants with hypertension, diabetes mellitus and liver cirrhosis. CBD injury occurred in 5 % of cases, and it was significantly associated with cholecystitis, gallstones, gallbladder polypoid lesions, poor identification of the hepatic pedicle, technical mistakes, and difficult cases. No significant correlations were found between CBD injury and comorbidities or specific causes. Conclusion: CBD injury was linked to cholecystitis, gallstones, gallbladder polypoid lesions, poor hepatic pedicle identification, gallbladder inflammation, cumulative technical errors, and difficult cases. Surgeons should be vigilant during hepatic pedicle identification and dissection to avoid CBD damage. Cholecystitis, gallstones, and associated conditions need suitable treatment to ease symptoms.

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Section: Discussionmentioning

confidence: 87%

Predective Factors of Common Bile Duct Injury in Laparoscopic Cholecystectomy

2024

The Egyptian Journal of Hospital Medicine

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“…Cholecystitis, characterized by gallbladder inflammation, is typically caused by cystic duct obstruction from gallstones and can have a prolonged course with a high risk of recurrence [ 17 , 18 ]. Research indicates that approximately 95% of cholecystitis cases are associated with gallstones [ 19 ]. Delayed intervention can result in chronic cystic bile duct obstruction, leading to gallbladder lumen dilation and wall enlargement due to submucosal edema, which can exacerbate the physical and psychological burden on patients and complicate treatment.…”

Section: Discussionmentioning

confidence: 99%

The value of preoperative neutrophil/lymphocyte ratio in predicting the severity of cholecystolithiasis with cholecystitis in elderly patients

Xia,

Liu,

Sun

et al. 2023

BMC Surg

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Background This study aims to assess the effectiveness of neutrophil/lymphocyte ratio (NLR) and C-reactive protein (CRP) in diagnosing cholecystolithiasis with cholecystitis in elderly patients. Additionally, the study seeks to determine the predictive value of preoperative NLR in determining the severity of the condition in this population. Methods This study is a retrospective cohort study, including 160 elderly patients with cholecystolithiasis with cholecystitis (45 cases of simple cholecystitis, 58 cases of suppurative cholecystitis, 57 cases of gangrenous cholecystitis) and 60 cases of normal gallbladder histology. The study collected clinical data of the patients detected the preoperative CRP content, neutrophil, and lymphocyte levels through blood routine tests, and calculated the NLR value. The diagnostic value of NLR and CRP was determined by using the Receiver Operating Characteristic Curve (ROC), and the optimal value of preoperative NLR related to the severity of elderly patients with cholecystolithiasis with cholecystitis was identified. Results This study found that for elderly patients with cholecystolithiasis with cholecystitis, preoperative NLR and CRP levels can be used to distinguish the condition. The critical value for NLR was found to be 2.995 (95% CI, 0.9465–0.9853; P < 0.001) with an area under the ROC curve of 0.9659, while the critical value for CRP was 13.05 (95% CI, 0.9284–0.9830; P < 0.001) with an area under the ROC curve of 0.9557. Both NLR and CRP were found to have equivalent diagnostic abilities. Additionally, the study found that there were significant differences in neutrophil and lymphocyte levels in elderly patients with different severity levels, with NLR increasing as severity increased (P < 0.001). The study identified cut-off values for preoperative NLR that could distinguish Simple cholecystitis and Purulent cholecystitis, as well as Purulent cholecystitis and Gangrenous cholecystitis in elderly patients with cholecystolithiasis, with respective AUCs of 0.8441 (95% CI: 0.7642–0.9239; P < 0.001) and 0.7886(95% CI: 0.7050–0.8721, P < 0.001), sensitivities of 91.38% and 87.72%, and specificities of 73.33% and 63.79%. Conclusions Preoperative NLR and CRP values can serve as indicators to detect cholecystolithiasis with cholecystitis in elderly patients. Additionally, NLR has been recognized as a potential tool to differentiate the severity of cholecystolithiasis with cholecystitis in the elderly population.

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“…The US is a highly sensitive diagnostic method for gallstone ileus, and in combination with radiography, it is accurate up to 74% [4,5]. CT has a sensitivity of up to 93% [10,11].…”

Section: Discussionmentioning

confidence: 99%

Cholecystoduodenal fistula and gallstone ileus - diagnosis and surgical treatment

et al. 2022

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Introduction. Gallstone ileus is a complete or partial mechanical bowel obstruction due to gallstone impaction in the bowel lumen and most commonly occurs after stones migrate through the cholecystoenteric fistula. Case outline. We present a patient with signs of gallstone ileus after stone migration through the cholecystoduodenal fistula into the duodenum with hematemesis as the first symptom. Conservative treatment has been started, to which the patient initially responds well. On the eighth day from the onset of the disease, the condition worsens. Signs of the Riegler triad are identified on computed tomography and magnetic resonance imaging of the abdomen. Enterolytotomy was successfully performed by open surgical method. Postoperative recovery is orderly, without any biliary problems. Conclusion. Physical examination, upper endoscopy, and radiological diagnostic procedures are complementary and necessary in monitoring the dynamics of stone movement and deciding on when to perform surgery.

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Beyond acute cholecystitis—gallstone-related complications and what the emergency radiologist should know

Cited by 8 publications

References 70 publications

Predective Factors of Common Bile Duct Injury in Laparoscopic Cholecystectomy

Predective Factors of Common Bile Duct Injury in Laparoscopic Cholecystectomy

The value of preoperative neutrophil/lymphocyte ratio in predicting the severity of cholecystolithiasis with cholecystitis in elderly patients

Cholecystoduodenal fistula and gallstone ileus - diagnosis and surgical treatment

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