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A case of typhoidal acalculous cholecystitis is described in a 31-year-old Indian man, who was admitted with 4-day fever, abdominal pain, diarrhea and vomiting. On examination, he looked ill, but was conscious and febrile with ict...
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A case of typhoidal acalculous cholecystitis is described in a 31-year-old Indian man, who was admitted with 4-day fever, abdominal pain, diarrhea and vomiting. On examination, he looked ill, but was conscious and febrile with icteric sclera. The right upper quadrant of the abdomen was tender. Investigations showed high liver enzymes with high total bilirubin. Abdominal ultrasound findings were consistent with the diagnosis of acalculous cholecystitis and Salmonella enterica serovar typhi was isolated from the blood. After a 2-week course of ceftriaxone (2 g once daily) the patient made an uneventful recovery and was discharged. In this report the literature is reviewed and the pathogenesis of the disease is discussed.
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摘要 :
A case of typhoidal acalculous cholecystitis is described in a 31-year-old Indian man, who was admitted with 4-day fever, abdominal pain, diarrhea and vomiting. On examination, he looked ill, but was conscious and febrile with ict...
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A case of typhoidal acalculous cholecystitis is described in a 31-year-old Indian man, who was admitted with 4-day fever, abdominal pain, diarrhea and vomiting. On examination, he looked ill, but was conscious and febrile with icteric sclera. The right upper quadrant of the abdomen was tender. Investigations showed high liver enzymes with high total bilirubin. Abdominal ultrasound findings were consistent with the diagnosis of acalculous cholecystitis and Salmonella enterica serovar typhi was isolated from the blood. After a 2-week course of ceftriaxone (2 g once daily) the patient made an uneventful recovery and was discharged. In this report the literature is reviewed and the pathogenesis of the disease is discussed.
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We report a case of acute acalculous cholecystitis with eosinophilic infiltration. A previously healthy 6-year-old boy was referred with right abdominal pain. Imaging demonstrated marked thickening of the gallbladder wall and peri...
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We report a case of acute acalculous cholecystitis with eosinophilic infiltration. A previously healthy 6-year-old boy was referred with right abdominal pain. Imaging demonstrated marked thickening of the gallbladder wall and peri-cholecystic effusion. Acute acalculous cholecystitis was diagnosed. Symptoms persisted despite conservative treatment, therefore cholecystectomy was performed. Pathology indicated infiltration of eosinophils into all layers of the gallbladder wall. The postoperative course was uneventful and the patient has had no further symptoms. Eosinophilic cholecystitis is acute acalculous cholecystitis with infiltration of eosinophils. The causes include parasites, gallstones, allergies, and medications. In addition, it may be seen in conjunction with eosinophilic gastroenteritis, eosinophilic pancreatitis, or both. An allergic reaction to abnormal bile is thought to be the underlying cause. The present case did not fulfill the diagnostic criteria of eosinophilic cholecystitis, but this may have been in the process of developing.
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Acute cholecystitis is defined as inflammation of the gallbladder and is usually caused by obstruction of the cystic duct. Cholescintigraphy is the most sensitive imaging modality for cholecystitis. The gold standard treatment of ...
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Acute cholecystitis is defined as inflammation of the gallbladder and is usually caused by obstruction of the cystic duct. Cholescintigraphy is the most sensitive imaging modality for cholecystitis. The gold standard treatment of acute cholecystitis is laparoscopic cholecystectomy. Operating early in the disease course decreases overall hospital stay and avoids increased complications, conversion to open procedures, and mortality. Cholecystitis during pregnancy is a challenging problem for surgeons. Operative intervention is generally safe for both mother and fetus, given the improved morbidity of the laparoscopic approach compared with open, although increased caution should be exercised in women with gallstone pancreatitis.
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Background Acute cholecystitis (AC) is a severe complication after cardiovascular surgery (CS). The purpose of this study was to delineate the clinical picture of AC after CS to propose an optimal treatment strategy.
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Introduction: Critical care patients have many risk factors for acute cholecystitis (AC). However, less data are available regarding newly developed AC in critically ill patients.
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OBJECTIVE. The purpose of this study was to determine the incremental value of the presence of cystic duct enhancement for diagnosing acute cholecystitis without visible impacted gallstones.
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Abstract Objectives To examine the outcomes of percutaneous cholecystostomy (PC) in patients with acute acalculous cholecystitis (AAC). Methods The study population comprised 271 patients (mean age, 72 years; range, 22–97 years, ...
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Abstract Objectives To examine the outcomes of percutaneous cholecystostomy (PC) in patients with acute acalculous cholecystitis (AAC). Methods The study population comprised 271 patients (mean age, 72 years; range, 22–97 years, male, n=169) with AAC treated with PC with or without subsequent cholecystectomy. Clinical data from total 271 patients were analysed, and outcomes were assessed according to whether the catheter was removed or remained indwelling. Patient survival and recurrence rates were calculated. Results Symptom resolution and significant improvement of laboratory test values were achieved in 235 patients (86.7%) within 4 days after PC. Complications occurred in six patients (2.2%). Interval elective cholecystectomy was performed in 127 (46.8%) patients. Among the remaining 121 patients, successful removal of the PC catheter was achieved in 88 patients (72.7%) at a mean of 30 days (range, 4–365 days). Of the catheter removal group, 86/88 (97.7%) were successfully treated with the initial PC, whereas two (2.3%) experienced recurrence of cholecystitis. Cumulative recurrence rates were 1.1%, 2.7%, and 2.7% at 1, 2, and 8 years, respectively. Conclusions The good therapeutic outcomes of PC and low recurrence rate suggest that PC can be a definitive treatment option in the majority of AAC patients. Key Points ? Many patients with AAC are too ill to undergo cholecystectomy . ? PC in AAC patients shows low complication and recurrence rate . ? PC solely can be a definitive treatment option in the majority of AAC patients
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GRUNDLAGEN: Während die akute konkrementassoziierte Cholezystitis eine bekannte Komplikation nach Nierentransplantation darstellt, tritt eine akalkulöse Cholezystitis extrem selten auf. METHODIK (FALLBERICHT): Wir berichten zwei...
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GRUNDLAGEN: Während die akute konkrementassoziierte Cholezystitis eine bekannte Komplikation nach Nierentransplantation darstellt, tritt eine akalkulöse Cholezystitis extrem selten auf. METHODIK (FALLBERICHT): Wir berichten zwei Fälle von akalkulöser Cholezystitis während der frühen postoperativen Phase nach Nierentransplantation. ERGEBNISSE: Beide Patienten boten eine prolongierte postoperative Paralyse und entwickelten das Bild eines akuten Abdomens, was am 8. bzw. 9. Postoperativen Tag zu einer Akutlaparotomie veranlasste. Intraoperativ zeigte sich in beiden Fällen eine nekrotisierende Cholezystitis, bei einem Patienten mit Gallenblasenperforation und biliärer Pankreatitis. Nach erfolgter Cholezystektomie, Peritoneallavage und Drainage konnten beide Patienten schließlich mit zufriedenstellender Transplantatfunktion entlassen werden. SCHLUSSFOLGERUNGEN: Die akalkulöse Cholezystitis stellt eine seltene, aber schwerwiegende Komplikation nach Nierentransplantation dar. Aufgrund des Fehlens von eindeutigen klinischen Symptomen ist eine besondere Wachsamkeit geboten. Die Cholezystektomie ermöglicht als Therapie der Wahl die Erhaltung der Transplantatfunktion.
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The patient was a 67-year-old man with advanced hepatocellular carcinoma (HCC) due to chronic hepatitis B. Due to refractoriness to radiofrequency ablation and transcatheter arterial chemoembolization, lenvatinib, a new oral mutik...
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The patient was a 67-year-old man with advanced hepatocellular carcinoma (HCC) due to chronic hepatitis B. Due to refractoriness to radiofrequency ablation and transcatheter arterial chemoembolization, lenvatinib, a new oral mutikinase inhibitor, was started with a daily dose of 12 mg. However, on day 6 the patient developed acute-onset, right upper quadrant pain associated with fever; laboratory tests revealed leukocytosis and liver dysfunction. CT scan showed the swollen gallbladder with wall thickening with no evidence of gallstones, and the diagnosis of acute acalculous cholecystitis was made. After the resolution of cholecystitis by antibiotics and endoscopic nasogallbladder drainage placement, lenvatinib was resumed at a reduced daily dose of 4 mg. However, acute acalculous cholecystitis recurred, supporting lenvatinib as a cause of acute acalculous cholecystitis. Using the Naranjo adverse drug reaction probability scale, a score of 6 was derived, which indicates that this adverse event was probably caused by lenvatinib. In summary, we present a patient with advanced HCC who underwent repeated episodes of acute acalculous cholecystitis as a rare adverse event associated with lenvatinib.
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