Huge gangrenous gallbladder presenting as gastro-esophageal reflux disease successfully treated by laparoscopic cholecystectomy: Case report and literature review

Elkbuli, Adel; Meneses, Evander; Kinslow, Kyle; McKenney, Mark; Boneva, Dessy

doi:10.1016/j.ijscr.2020.09.193

Cited by 4 publications

(7 citation statements)

References 12 publications

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“…Figure 7 clearly indicates the importance of bilirubin as an indicator of malignant biliary obstruction, where the cut-off value for bilirubin concentration serves as an indicator for the type of disease (i.e., above 11 µmol/L choledocholithiasis is likely, and above 59 µmol/L a neoplasm may be suspected). This is in line with the previous model of the less complete closure caused by the cholestasis [ 79 ]. The ratio of conjugated to unconjugated BSs was found to be a significant indicator for healthy patients (thus the line is below the diagonal [ 80 ]) when compared with cholestasis and neoplasm patients, with a ratio of 80.3 and 48.7, respectively.…”

Section: Resultssupporting

confidence: 93%

Importance of Bile Composition for Diagnosis of Biliary Obstructions

et al. 2021

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Determination of the cause of a biliary obstruction is often inconclusive from serum analysis alone without further clinical tests. To this end, serum markers as well as the composition of bile of 74 patients with biliary obstructions were determined to improve the diagnoses. The samples were collected from the patients during an endoscopic retrograde cholangiopancreatography (ERCP). The concentration of eight bile salts, specifically sodium cholate, sodium glycocholate, sodium taurocholate, sodium glycodeoxycholate, sodium chenodeoxycholate, sodium glycochenodeoxycholate, sodium taurodeoxycholate, and sodium taurochenodeoxycholate as well as bile cholesterol were determined by HPLC-MS. Serum alanine aminotransferase (ALT), aspartate transaminase (AST), and bilirubin were measured before the ERCP. The aim was to determine a diagnostic factor and gain insights into the influence of serum bilirubin as well as bile salts on diseases. Ratios of conjugated/unconjugated, primary/secondary, and taurine/glycine conjugated bile salts were determined to facilitate the comparison to literature data. Receiver operating characteristic (ROC) curves were determined, and the cut-off values were calculated by determining the point closest to (0,1). It was found that serum bilirubin was a good indicator of the type of biliary obstruction; it was able to differentiate between benign obstructions such as choledocholithiasis (at the concentration of >11 µmol/L) and malignant changes such as pancreatic neoplasms or cholangiocarcinoma (at the concentration of >59 µmol/L). In addition, it was shown that conjugated/unconjugated bile salts confirm the presence of an obstruction. With lower levels of conjugated/unconjugated bile salts the possibility for inflammation and, thus, neoplasms increase.

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Section: Resultssupporting

confidence: 93%

Importance of Bile Composition for Diagnosis of Biliary Obstructions

et al. 2021

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“…Various studies have shown that direct operating theatre costs are calculated and range from £14 to £40 per minute in the NHS and $30 to $100 per minute in the USA. Surgical care accounts for approximately one-third of healthcare costs and aggregates half of the inpatient hospital costs 8, 25,26,27,28,29 . One of the factors for poor theatre utilization was over-or underbooking theatre lists and unexpected cancellations costing the different healthcare systems millions.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, the Tokyo Guidelines 9 predominantly consider preoperative factors, while the AAST 12 and PGS 11 guidelines focus on intraoperative factors assessed preoperatively through imaging. Elkbuli et al 29 underscore the drawbacks of existing tools, emphasizing the misalignment of preoperative ndings with intraoperative exploration. The authors highlighted that the PGS is promising for capturing gallbladder appearances but failed to detect its de ciency in considering gallbladder size, a crucial factor related to complications.…”

Section: Discussionmentioning

confidence: 99%

Using video analytics to standardise complexity of Gallbladder surgery

Naseem,

Tam,

Naseem

et al. 2024

Preprint

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Background: Cholecystitis is a widespread disease with an associated spectrum of complications; hence, laparoscopic cholecystectomies are commonly performed. Current grading scales are quantitative and objective. There is a need for a dynamic scoring tool that can help standardise training, theatre scheduling, and utilisation and could be incorporated into artificial intelligence. Aim/Hypothesis: • To develop and validate a dynamic scoring tool that incorporates the procedure's difficulty and severity of cholecystitis in correlation to operation time. • We hypothesise that a higher score correlates positively with increasing time, which could dynamically enhance operating room efficiency and turnover. Material & Method: A retrospective review of n = 123 LC videos of anonymised patients of Royal Cornwall Hospital NHS Trust, Treliske, the UK, between April 2019 - September 2021 was performed. A scoring system was proposed to analyse the correlation between cholecystitis severity, the difficulty of the operation and operative time. The tool comprised variables such as gall bladder characteristics, operative steps, anomalies, and additional procedures. Results: During the study period, n = 123 cholecystectomy procedures were analysed, n = 81 (65.85%) met the inclusion criteria and n=42 (34.15%) were excluded. The average total score per video was 8.63, with an average completion time of approx. 65 minutes. The results confirmed a positive correlation of R= 0.791 between higher scores leading to extended operative time. Further analysis showed a positive correlation of R= 0.607 was achieved between the Initial Assessment Score and the Initial Assessment Time to assess the gall bladder characteristics. Additionally, a strong positive correlation of R= 0.944 was attained for Total Score, Completion Time, and Initial Assessment Score. Conclusion: The proposed grading scale is a practical predictor of the complexity of the procedure in correlation with the duration of the operation. The grading scale should be helpful in surgical training and improved theatre scheduling and utilisation.

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“…Giant gallbladders are associated with various obstructions of the cystic duct of the bile duct, such as stones, parasites, or tumors. [1,7,8] There are also sporadic reports of gallbladder neck gangliocytopenia leading to dilated gallbladder. [6] In this patient, there was no cystic duct obstruction or any other underlying disease.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic cholecystectomy for giant gallbladder: A case report

Gao,

He,

Feng

et al. 2023

Medicine

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Rationale: An overdistended gallbladder is usually observed in cases of distal bile obstruction due to malignancy. The gallbladder may also become enlarged and distended during cystic duct or gallbladder neck obstruction due to gallstones. However, a grossly distended gallbladder ( > 14 cm in length) without any pathology is rare. We present the case of a 46-year-old female patient who suffered from acute right lower quadrant pain for 4 days. Initially, a liver cyst and a choledochal cyst were diagnosed by the local hospital. Then, the diagnosis of giant gallbladder (measuring approximately 20.0 cm × 7.0 cm and containing more than 30 gallbladder stones) was made by magnetic resonance cholangiopancreatography at our hospital. Finally, we successfully performed a laparoscopic cholecystectomy and the patient had an uneventful recovery. Patient concerns: A 46-year-old female patient presented with acute right lower quadrant pain lasting 4 days. At first, the abdominal pain was severe and paroxysmal, and then it subsided spontaneously. Computed tomography of the abdomen at another hospital revealed a hepatic cyst and a choledochal cyst. Come to our hospital for surgical treatment. Diagnoses: giant gallbladder with gallstones. Interventions: Laparoscopic cholecystectomy was successfully performed in this patient after decompressing the gallbladder. Outcomes: On the third postoperative day, the patient recovered well, and the abdominal pain resolved following the operation. At the 3-year postoperative follow-up, the patient was symptom-free, with no obvious abnormalities seen in liver function and hepatobiliary color Doppler ultrasound. Lessons: The patient was successfully treated using laparoscopic cholecystectomy. This rare case may contribute to the development of mechanisms for treating giant gallbladders.

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Huge gangrenous gallbladder presenting as gastro-esophageal reflux disease successfully treated by laparoscopic cholecystectomy: Case report and literature review

Cited by 4 publications

References 12 publications

Importance of Bile Composition for Diagnosis of Biliary Obstructions

Importance of Bile Composition for Diagnosis of Biliary Obstructions

Using video analytics to standardise complexity of Gallbladder surgery

Laparoscopic cholecystectomy for giant gallbladder: A case report

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