Evidence-Based Management of Common Gallstone-Related Emergencies

Abstract

Gallstone-related disease is among the most common clinical problems encountered worldwide. The manifestations of cholelithiasis vary greatly, ranging from mild biliary colic to life-threatening gallstone pancreatitis and cholangitis. The vast majority of gallstone-related diseases encountered in an acute setting can be categorized as biliary colic, cholecystitis, choledocholithiasis, and pancreatitis, although these diagnoses can overlap. The management of these diseases is uniquely multidisciplinary, involving many specialties and treatment options. Thus, care may be compromised due to redundant tests, treatment delays, or inconsistent management. This review outlines the evidence for initial evaluation, diagnostic workup, and treatment for the most common gallstone-related emergencies. Key principles include initial risk stratification of patients to aid in triage and timing of interventions, early initiation of appropriate antibiotics for patients with evidence of cholecystitis or cholangitis, patient selection for endoscopic biliary decompression, and growing evidence in favor of early laparoscopic cholecystectomy for clinically stable patients.

Comparison of mean pain scores for the patients with sub hepatic drainage to those without it after elective uncomplicated laparoscopic cholecystectomy

“…Results of majority of the studies conducted in different populations of the world in establishing role of sub hepatic drain in laparoscopic cholecystectomy patients revealed that it is associated with significant postoperative pain, increases discomfort as well as hospital stay for the patients 16,17,18. Laparoscopic cholecystectomy is primarily aimed at reducing patient’s pain, hospital stay and allows the patient a smooth and quick recovery from the operation 19,20.…”

Acute Calculous Cholecystitis in a Young Female Patient: A Unique Case

“…Right upper quadrant ultrasound has >95% sensitivity and specificity to detect gallbladder stone. 9 However, its sensitivity and specificity for diagnosing acute cholecystitis was relatively low. In the study by Borzellino et al, distention of the gallbladder, wall edema, and pericholecystitis fluid collection were used as the criteria for the presence of acute calculous cholecystitis.…”

Incidence of gallstones after gastric resection for gastric cancer: a nationwide claims-based study

“…Third, there might exist false negative patients in the present study. In general, CT scan is inferior to ultrasonography in detecting gallstones [ 22 ]. Therefore, gallstones are might to be missed at the institution in which CT scan is a major follow-up modality rather than ultrasonography.…”