Karimian F, Rabbani A, Nik Kholgh A,
Volume 58, Issue 4 (7-2000)
Abstract
Since its introduction in 1988, laparoscopic cholecystectomy (LC) has become the procedure of choice in the management of gallstone disease. It has well established advantages compared to its traditional open counterpart such as reduction in hospital stay and related costs, more rapid return to work, and reduction in pain and cosmetic problems. LC, like any other procedure, has its own indications and contraindications that have been modified due to the improvement in laparoscopic technics and surgical skills. The goal of this article is to review these indications and contraindications in surgical wards 1 and 5-Imam Khomeini medical center-Tehran. In a retrospective descriptive case-series, patient records of all cholecystectomies from 1993 till 1998 were studied. Patients age and sex, diagnosis at admission, sonographic and/or other radiologic findings, lab data, indication of cholecystectomy, co-existent clinical situation, history of abdominal operation and/or malignancy, type of operation (LC, open, converted to open and its cause), intra-operative findings, pathologic findings, days from operation to discharge, and early mortality rate were reviewed. 343 cholecystectomies were studied, among which 121 were laparoscopic. In the laparoscopic group, there were 117 (96.6%) women and 4 (3.3%) men. Age range was 14 to 84 with the median of 45. The most common indications for LC in this center are: 1) Recurrent biliary colic (88.4%), 2) Non-specific manifestations of gallstone (5.8%) and 3) Asymptomatic gallstone (1.7%). Contraindications for LC are: 1) Acute cholecystitis 2) CBD stone and/or dilatation, 3) Gallbladder cancer, 4) Intra-abdominal malignancies, 5) The need for other elective abdominal operation, 6) History of upper abdominal, laparatomy, 7) Sepsis, 8) Ileus, 9) Peritonitis, 10) Pancreatitis and 11) Morbid obesity. Compensated cirrhosis of the liver is not a contraindication to LC. LC in cardiac and respiratory patients requires exact evaluations and decision making is based on patient's general condition. The conversion to open rate was 7.4% (9 of 121 cases). Causes of conversion were: Severe adhesions, technical and enforced. There was no death after LC.
Seyed Hassan Seyed Sharifi , Ghodratollah Maddah, Mohammad Etezadpour,
Volume 79, Issue 6 (9-2021)
Abstract
Background: Emphysematous cholecystitis is a rare variant of acute cholecystitis with high mortality and morbidity rate. Emphysematous cholecystitis most often occurs in older men and Emphysematous cholecystitis often occurs in patients with chronic diseases such as diabetes and vascular disease. The combination of emphysematous cholecystitis and pneumoperitoneum is even rarer. In this study, we reported a rare case of pneumoperitoneum on plain abdominal X-ray with emphysematous cholecystitis in an 83-year-old woman.
Case Presentation: The patient was 83 years old, lady who had been referred to the emergency department of Ghaem Hospital, Mashhad University of Medical Sciences in April 2019, due to diffuse abdominal pain that had started suddenly 3 days earlier. Pneumoperitoneum, the air in the gallbladder wall and the air encircling the gallbladder were reported in standing and supine abdominal x-rays and standing chest X-rays. At first, the patient was resuscitated and treated with broad-spectrum antibiotics. After initial treatment, the patient underwent open cholecystectomy with a subcostal incision on the right and a diagnosis of emphysematous cholecystitis. After surgery, the patient's general condition improved and she was discharged without mortality and morbidity with oral third-generation Cephalosporin antibiotics. The general condition of the patient after discharge was good in the examinations performed in the clinic of Ghaem Hospital, 1 and 3 months after discharge.
| Conclusion: Emphysematous cholecystitis is a rare and severe form of acute cholecystitis that occurs due to the process of arterial ischemia caused by contamination with anaerobic bacteria and the formation of gas in the wall and lumen of the gallbladder. Emphysematous cholecystitis is more severe than other types of acute cholecystitis and has higher mortality and morbidity and is life-threatening. Due to the acute and progressive course of emphysematous cholecystitis, correct and timely diagnosis and treatment are important. |
