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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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BACKGROUND: Acute gangrenous cholecystitis (AGC) is a medical emergency that carries high morbidity. The objective of this study is to define risk factors for this disease.
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The World Society of Emergency Surgery (WSES) was established in 2007. The objectives set forth by the society, as enumerated in the mission statement, is: “The overall goals include the promotion of the specialty of emergency su...
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The World Society of Emergency Surgery (WSES) was established in 2007. The objectives set forth by the society, as enumerated in the mission statement, is: “The overall goals include the promotion of the specialty of emergency surgery as part of the emerging discipline of acute care surgery via academic exchange in an effort to further training and education as well as translational research in the specialty’.
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Purpose: To retrospectively determine the sensitivity and specificity of magnetic resonance (MR) imaging for differentiation between acute and chronic cholecystitis, with histopathologic analysis as the reference standard. Materia...
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Purpose: To retrospectively determine the sensitivity and specificity of magnetic resonance (MR) imaging for differentiation between acute and chronic cholecystitis, with histopathologic analysis as the reference standard. Materials and Methods: Institutional review board approval with waived informed consent was obtained for this HIPAA-compliant study. Four reviewers blinded to the cholecystitis type but aware that cholecystitis was present retrospectively evaluated MR images for predetermined findings in 32 patients (15 male, 17 female; mean age +/- standard deviation, 55 years +/- 20) with histopathologically proved acute or chronic cholecystitis. The final MR diagnoses and MR findings in both groups were compared with each other and with the histopathologic diagnoses to determine the sensitivity and specificity of MR imaging. chi(2) tests were used to detect differences in MR findings between the acute and chronic cholecystitis groups. Results: MR imaging sensitivity and specificity for detection of acute cholecystitis were 95% (18 of 19 patients) and 69% (nine of 13 patients), respectively. The sensitivities of increased gallbladder wall enhancement and increased transient pericholecystic hepatic enhancement were 74% (14 of 19 patients) and 62% (10 of 16 patients), respectively. Both findings had 92% (12 of 13 patients) specificity. Sensitivities of increased wall thickness, pericholecystic fluid, and adjacent fat signal intensity changes were 100% (19 of 19 patients), 95% (18 of 19 patients), and 95% (18 of 19 patients), respectively; specificities were 54% (seven of 13 patients), 38% (five of 13 patients), and 54% (seven of 13 patients), respectively. Pericholecystic abscess, intraluminal membranes, and wall irregularity or defect each had 100% (13 of 13 patients) specificity; sensitivities were 11% (two of 19 patients), 26% (five of 19 patients), and 21% (four of 19 patients), respectively. Increased gallbladder wall enhancement (P < .001) and increased transient pericholecystic hepatic enhancement (P = .003) were the most significantly different between acute and chronic cholecystitis. Conclusion: Increased gallbladder wall enhancement and increased transient pericholecystic hepatic enhancement had the highest combination of sensitivity and specificity for the diagnosis and differentiation of acute and chronic cholecystitis. (c) RSNA, 2007.
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Backgrounds/Aims Laparoscopic cholecystectomy within one week of acute cholecystitis is considered safe and advantageous. Surgery beyond first week is reserved for non-resolving attack or complications. To compare clinical outcome...
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Backgrounds/Aims Laparoscopic cholecystectomy within one week of acute cholecystitis is considered safe and advantageous. Surgery beyond first week is reserved for non-resolving attack or complications. To compare clinical outcomes of patients undergoing laparoscopic cholecystectomy in the first week and between two to six weeks of an attack of acute cholecystitis. Methods In an analysis of a prospectively maintained database, all patients who underwent laparoscopic cholecystectomy for acute cholecystitis were divided into two groups: group A, operated within one week; and group B, operated between two to six weeks of an attack. Main variables studied were mean operative time, conversion to open cholecystectomy, morbidity profile, and duration of hospital stay. Results A total of 116 patients (74 in group A and 42 in group B) were included. Mean interval between onset of symptoms & surgery was five days (range, 1–7 days) in group A and 12 days (range, 8–20 days) in group B. Operative time and incidence of subtotal cholecystectomy were higher in group B (statistically not significant). Mean postoperative stay was 2 days in group A and 3 days in group B. Laparoscopy was converted to open cholecystectomy in two patients in each group. There was no incidence of biliary injury. One patient in group B died during the postoperative period due to continued sepsis and multiorgan failure. Conclusions In tertiary care setting, with adequate surgical expertise, laparoscopic cholecystectomy can be safely performed in patients with acute cholecystitis irrespective of the time of presentation.
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AIM: To determine whether the transhepatic or transperitoneal approach is the optimal percutaneous cholecystostomy approach. MATERIALS AND METHODS: A systematic review and meta-analysis was undertaken in which the Medline, EMBASE,...
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AIM: To determine whether the transhepatic or transperitoneal approach is the optimal percutaneous cholecystostomy approach. MATERIALS AND METHODS: A systematic review and meta-analysis was undertaken in which the Medline, EMBASE, and PubMed databases were searched for studies that compared both approaches in patients undergoing percutaneous cholecystostomy. Statistical analysis of dichotomous variables was carried out using odds ratio as the summary statistic. RESULTS: Four studies totalling 684 patients (396 [58%] males, mean age 74 years) who had undergone percutaneous cholecystostomy via the transhepatic (n=367) and transperitoneal (n=317) approach were analysed. Although the overall risk of bleeding was low (4.1%), it was significantly higher in the transhepatic approach compared with the transperitoneal approach (6.3% versus 1.6% respectively, odds ratio = 4.02 [1.56, 10.38]; p=0.004). There were no significant differences in pain, bile leak, tube-related complications, wound infection, or abscess formation between the approaches. CONCLUSION: Percutaneous cholecystostomy can be performed safely and successfully via the transhepatic and transperitoneal approaches. Although the overall rate of bleeding was significantly higher with the transhepatic approach, there were confounding factors due to technical differences between the studies. The small number of the included studies, in addition to variability of the definitions of outcomes, imposed other limitations. Further largevolume cases series and ideally a randomised trial with well-defined outcomes are required to confirm these findings. (c) 2023 Published by Elsevier Ltd on behalf of The Royal College of Radiologists.
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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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Abstract Management bundles that define items or procedures strongly recommended in clinical practice have been used in many guidelines in recent years. Application of these bundles facilitates the adaptation of guidelines and hel...
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Abstract Management bundles that define items or procedures strongly recommended in clinical practice have been used in many guidelines in recent years. Application of these bundles facilitates the adaptation of guidelines and helps improve the prognosis of target diseases. In Tokyo Guidelines 2013 ( TG 13), we proposed management bundles for acute cholangitis and cholecystitis. Here, in Tokyo Guidelines 2018 ( TG 18), we redefine the management bundles for acute cholangitis and cholecystitis. Critical parts of the bundles in TG 18 include the diagnostic process, severity assessment, transfer of patients if necessary, and therapeutic approach at each time point. Observance of these items and procedures should improve the prognosis of acute cholangitis and cholecystitis. Studies are now needed to evaluate the dissemination of these TG 18 bundles and their effectiveness. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47 . Related clinical questions and references are also included.
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BACKGROUND/PURPOSE: The aim of this study was to identify preoperative prognostic parameters for gangrenous cholecystitis to differentiate this subgroup of patients with acute cholecystitis in order to provide immediate surgical t...
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BACKGROUND/PURPOSE: The aim of this study was to identify preoperative prognostic parameters for gangrenous cholecystitis to differentiate this subgroup of patients with acute cholecystitis in order to provide immediate surgical therapy. METHODS: The medical records of patients who had an emergency cholecystectomy with the diagnosis of acute cholecystitis between January 2002 and June 2005 were reviewed retrospectively. Univariate and multivariate analysis were performed on the data. RESULTS: Out of 203 individuals with the clinical diagnosis of acute cholecystitis, 21 (10.3%) patients had a histological diagnosis of gangrenous cholecystitis. Multivariate analysis demonstrated an independent association of male sex, diabetes mellitus and white blood cell (WBC) count with the development of acute gangrenous cholecystitis. CONCLUSIONS: The risk for gangrenous cholecystitis is increased in male patients who have diabetes and a greater WBC count than 14 900/mm(3). Urgent surgical intervention should be considered for these patients because of the high morbidity and mortality rate of the condition.
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