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Rahim SEG, Alomari M, Khazaaleh S, Alomari A, Al Momani LA. Acute Reactive Acalculous Cholecystitis Secondary to Duodenal Ulcer Perforation. Cureus 2019; 11:e4331. [PMID: 31183310 PMCID: PMC6538406 DOI: 10.7759/cureus.4331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 03/26/2019] [Indexed: 01/10/2023] Open
Abstract
Acute cholecystitis is the inflammation of the gallbladder, classically caused by gall stones obstructing the cystic duct. In contrast, acalculous cholecystitis is a gallbladder inflammation occurring in the absence of cholelithiasis with a reported prevalence of 10% of all cases of acute cholecystitis. Reactive acalculous cholecystitis is an extremely rare subset of this disease that results from an adjacent inflammatory or infectious intra-abdominal process that may lead to gallbladder stasis, ischemia, and subsequent wall inflammation. Many factors have been associated with acalculous cholecystitis, including (but not limited to) hemodynamic instability, altered immunity, and biliary tree anomalies. Lack of specific signs and symptoms of this particular entity often delays the diagnosis. Herein, we present a rare case of acute, reactive, acalculous cholecystitis secondary to a perforated duodenal ulcer found incidentally during laparoscopic cholecystectomy.
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Affiliation(s)
- Shab E Gul Rahim
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA
| | | | | | - Ahmed Alomari
- Internal Medicine, The Hashmite University, Al-Zarqa, JOR
| | - Laith A Al Momani
- Internal Medicine, East Tennessee State University, Johnson City, USA
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Li Z, Shen H, Zhang Y, Lu M, Qiao X, Meng X, Sun B, Xue D, Zhang W. Metabolomic study of serum from rabbits with acute acalculous cholecystitis. Inflamm Res 2012; 61:987-95. [PMID: 22618202 DOI: 10.1007/s00011-012-0491-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 04/17/2012] [Accepted: 05/07/2012] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES (1)H-NMR is a powerful approach of metabolomics. This study aimed to apply it to detect the serum metabolites in rabbits with acute acalculous cholecystitis (AAC), and to analyze their potential roles in AAC. METHODS Fourteen rabbits were randomly divided into two groups, the AAC group and the CON group. In the AAC rabbit model, Escherichia coli solution was injected into the gallbladder, while same volume of saline, instead of E. coli solution, was injected into the gallbladder of the CON rabbit. General morphological, light microscopic and transmission electron microscopic observations were used to evaluate the model. Metabolic profiles of serum from rabbits with AAC were investigated through (1)H-NMR spectroscopy coupled with multivariate statistical analysis, such as principal components analysis and orthogonal partial least-squares discriminant analysis. RESULTS The pathohistology of gallbladders showed a significant difference between the two groups, proving the successful induction of inflammation in the gallbladders of the AAC group. The serum concentration of lipids (LDL and VLDL) increased during AAC, while the concentrations of phospholipids, lactic acid, 3-hydroxybutyric acid, lysine, citric acid, asparagine, histidine, glucose and some other small molecular metabolites decreased. CONCLUSION The profiling of serum metabolites in rabbits with acute acalculous cholecystitis changed significantly. These changes referred to the metabolic disturbance of carbohydrate, amino acids and lipids, inhibition of immunological functions and inflammation reaction.
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Affiliation(s)
- Zhituo Li
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, 23 Youzheng St, Nangang Dist, Harbin, 150001, Heilongjiang, People's Republic of China
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Shridhar Ganpathi I, Diddapur RK, Eugene H, Karim M. Acute acalculous cholecystitis: challenging the myths. HPB (Oxford) 2007; 9:131-4. [PMID: 18333128 PMCID: PMC2020791 DOI: 10.1080/13651820701315307] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute acalculous cholecystitis (AAC) is traditionally known to occur in critically ill patients, following cardiac surgery, abdominal vascular surgery, severe trauma, burns, prolonged fasting, total parenteral nutrition, or sepsis, and is believed to have a worse prognosis as compared with acute cholecystitis associated with stones. Our observation of de novo presentation of AAC in several outpatients in the absence of critical illness or predisposing factors prompted us to undertake this study. The aims of the present study were to examine the prevalence of AAC patients in the outpatient setting in our hospital, to identify associated risk factors and to assess the clinical course and outcome of these patients. PATIENTS AND METHODS All patients who had a cholecystectomy (laparoscopic or open surgery) for acute cholecystitis at National University Hospital from January 2001 to May 2005 were reviewed from a prospectively maintained database. The demographic characteristics, clinicopathologic features, operative parameters, postoperative course, and histopathology of the patients were reviewed. RESULTS Eleven of 133 patients with acute cholecystitis fulfilled the criteria for the diagnosis of AAC. Patients' ages ranged from 30 to 69 years (mean 52.39 years). All these patients presented as outpatients. None of the patients had any critical illness predisposing to AAC. The mean age was slightly less in the AAC group as compared with the remaining patients with acute cholecystitis (52.39 years vs 55.22 years, p=0.54). There was male predominance in the AAC group (male:female = 9:2). The time from admission to surgery, operative procedure, operative time, and postoperative stay were not statistically different from the remaining patients with acute cholecystitis. DISCUSSION AAC can occur in young and middle-aged healthy individuals, the presentation is no different from acute calculous cholecystitis, the prognosis is good if diagnosed and treated early.
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Affiliation(s)
- Iyer Shridhar Ganpathi
- Department of Surgery, National University Hospital, Yong Loo Lin School of MedicineSingapore
| | - Ravishankar K. Diddapur
- Department of Surgery, National University Hospital, Yong Loo Lin School of MedicineSingapore
| | - Huang Eugene
- Department of Surgery, National University Hospital, Yong Loo Lin School of MedicineSingapore
| | - Masud Karim
- Department of Surgery, National University Hospital, Yong Loo Lin School of MedicineSingapore
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Abstract
AIDS is an advanced disease with systemic and infectious complications that can be fatal. When a patient with AIDS presents with right upper quadrant or midepigastric pain, cholestasis, and symptoms of cholangitis, AIDS cholangiopathy should be suspected and appropriate diagnostic and therapeutic interventions should be initiated. Opportunistic infections such as Cryptosporidium and cytomegalovirus are the most common cause of AIDS cholangiopathy. Four distinct cholangiographic abnormalities have been demonstrated by endoscopic retrograde cholangiopancreatography, the most common being papillary stenosis with sclerosing cholangitis. Antimicrobial therapy is often ineffective. Highly active antiretroviral therapy may enhance immune function and offers the best medical therapy to clear the opportunistic infections. Ursodeoxycholic acid has a limited benefit in patients with sclerosing cholangitis and cholestasis. Endoscopic sphincterotomy has been shown to relieve pain and biliary obstruction in patients with papillary stenosis. Balloon dilation of strictures and stent placement decompress the biliary system and may be helpful. Cholecystectomy is recommended to treat acalculous cholecystitis, and celiac plexus block may be offered to patients with terminal disease and intractable abdominal pain.
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Affiliation(s)
- Tony E. Yusuf
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
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Wang AJ, Wang TE, Lin CC, Lin SC, Shih SC. Clinical predictors of severe gallbladder complications in acute acalculous cholecystitis. World J Gastroenterol 2003; 9:2821-3. [PMID: 14669342 PMCID: PMC4612061 DOI: 10.3748/wjg.v9.i12.2821] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the relationship between clinical information (including age, laboratory data, and sonographic findings) and severe complications, such as gangrene, perforation, or abscess, in patients with acute acalculous cholecystitis (AAC).
METHODS: The medical records of patients hospitalized from January1997 to December 2002 with a diagnosis of acute cholecystitis were retrospectively reviewed to find those with AAC, confirmed at operation or by histologic examination. Data collected included age, sex, white blood cell count, AST, total bilirubin, alkaline phosphatase, bacteriology, mortality, and sonographic findings. The sonographic findings were recorded on a 3-point scale with 1 point each for gallbladder distention, gallbladder wall thickness > 3.5 mm, and sludge. The patients were divided into 2 groups based on the presence (group A) or absence (group B) of severe gallbladder complications, defined as perforation, gangrene, or abscess.
RESULTS: There were 52 cases of AAC, accounting for 3.7% of all cases of acute cholecystitis. Males predominated. Most patients were diagnosed by ultrasonography (48 of 52) or computed tomography (17 of 52). Severe gallbladder complications were present in 27 patients (52%, group A) and absent in 25 (group B). Six patients died with a mortality of 12%. Four of the 6 who died were in group A. Patients in group A were significantly older than those in group B (mean 60.88 y vs. 54.12 y, P = 0.04) and had a significantly higher white blood cell count (mean 15885.19 vs. 9948.40, P = 0.0005). All the 6 patients who died had normal white blood cell counts with an elevated percentage of band forms. The most commonly cultured bacteria in both blood and bile were E. coli and Klebsiella pneumoniae. The cumulative sonographic points did not reliably distinguish between groups A and B, even though group A tended to have more points.
CONCLUSION: Older patients with a high white cell count are more likely to have severe gallbladder complications. In these patients, earlier surgical intervention should be considered if the sonographic findings support the diagnosis of AAC.
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Affiliation(s)
- Ay-Jiun Wang
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan, China.
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Abstract
Acute cholecystitis can develop without gallstones in critically ill or injured patients. However, the development of acute acalculous cholecystitis is not limited to surgical or injured patients, or even to the intensive care unit. Diabetes, malignant disease, abdominal vasculitis, congestive heart failure, cholesterol embolization, and shock or cardiac arrest have been associated with acute acalculous cholecystitis. Children may also be affected, especially after a viral illness. The pathogenesis of acute acalculous cholecystitis is a paradigm of complexity. Ischemia and reperfusion injury, or the effects of eicosanoid proinflammatory mediators, appear to be the central mechanisms, but bile stasis, opioid therapy, positive-pressure ventilation, and total parenteral nutrition have all been implicated. Ultrasound of the gallbladder is the most accurate diagnostic modality in the critically ill patient, with gallbladder wall thickness of 3.5 mm or greater and pericholecystic fluid being the two most reliable criteria. The historical treatment of choice for acute acalculous cholecystitis has been cholecystectomy, but percutaneous cholecystostomy is now the mainstay of therapy, controlling the disease in about 85% of patients. Rapid improvement can be expected when the procedure is performed properly. The mortality rates (historically about 30%) for percutaneous and open cholecystostomy appear to be similar, reflecting the severity of illness, but improved resuscitation and critical care may portend a decreased risk of death. Interval cholecystectomy is usually not indicated after acute acalculous cholecystitis in survivors; if the absence of gallstones is confirmed and the precipitating disorder has been controlled, the cholecystostomy tube can be pulled out after the patient has recovered.
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Affiliation(s)
- Philip S Barie
- Department of Surgery, NewYork-Presbyterian Hospital, Weill Medical College of Cornell University, 525 East 68th Street, P-713A, New York, NY 10021, USA.
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Vibert E, Azoulay D. [Alithiasic cholecystitis in the adult: etiologies, diagnosis and treatment]. ANNALES DE CHIRURGIE 2002; 127:330-6. [PMID: 12094414 DOI: 10.1016/s0003-3944(02)00768-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Acalculous cholecystitis represents 2% to 14% of cholecystectomies performed for acute cholecystitis. Its main etiology is ischemia of the gallbladder wall, which mainly occurs in critically ill patients, particularly in case of cardiovascular previous disease or diabetes. Acalculous cholecystitis associated with VIH are rare and have a better prognosis. Other etiologies are exceptional. Diagnosis of acalculous cholecystitis is difficult, with a lack of specificity of abdominal ultrasound for the diagnosis of ischemic cholecystitis. In all cases, cholecystectomy is a definitive treatment allowing certain diagnosis. Percutaneous drainage must be reserved to patients whose general condition does not allow general anesthesia. Medical treatment alone is not indicated in acalculous cholecystitis.
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Affiliation(s)
- E Vibert
- Centre hépato-biliaire, hôpital Paul-Brousse, université Paris-Sud UPRES 1596, 94804 Villejuif, France
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Parithivel VS, Gerst PH, Banerjee S, Parikh V, Albu E. Acute Acalculous Cholecystitis in Young Patients without Predisposing Factors. Am Surg 1999. [DOI: 10.1177/000313489906500417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report the atypical presentation of acute acalculous cholecystitis in four young, otherwise healthy patients. These cases emphasize the fact that the traditional concept of this disease as being associated with trauma, major surgery, or other pathology may no longer be true, and an important number of cases may appear de novo in patients without any predisposing factors.
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Affiliation(s)
| | - Paul H. Gerst
- Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, New York
| | | | - Virendra Parikh
- Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, New York
| | - Eugene Albu
- Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, New York
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Cacciarelli AG, Naddaf SY, el-Zeftawy HA, Aziz M, Omar WS, Kumar M, Atay S, Abujudeh H, Gillooley J, Abdel-Dayem HM. Acute cholecystitis in AIDS patients: correlation of Tc-99m hepatobiliary scintigraphy with histopathologic laboratory findings and CD4 counts. Clin Nucl Med 1998; 23:226-8. [PMID: 9554194 DOI: 10.1097/00003072-199804000-00007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AIDS patients are susceptible to opportunistic gastrointestinal infections including ascending cholangitis and cholecystitis, especially if CD4 count is < 200. Incidence of acalculous cholecystitis has not been reported previously. PURPOSE We aim to evaluate the incidence of acalculous cholecystitis in AIDS patients and to identify causative organisms and mortality rate following cholecystectomy. MATERIALS AND METHODS We reviewed the files of 46 patients in order to meet the objectives of this study. RESULTS CD4 counts were < 200 in 31 patients and > 200 in 15 patients. HIDA imaging was performed in 31 patients; in 8, the CD4 count was > 200 and all had calculous cholecystitis. The gallbladder was visualized in 3 patients for a sensitivity of 63% and no organisms were found in the gallbladder specimens. In 23 patients, the CD4 count was < 200; the gallbladder was visualized in 5 patients for a HIDA sensitivity of 78%; 16 (52%) had acalculous cholecystitis; and 15 had calculous cholecystitis. In acalculous cholecystitis, Cryptosporidium was found in six cases, cytomegalovirus (CMV) in six cases, and fungus, yeast, tuberculosis, and mycobacterium avium intracellular each in one case. The thirty day mortality rate was 18%; 5 of 28 who underwent open cholecystectomy died within 30 days, 4 of them with a CD4 count < 200. There was no mortality in the 26 patients who underwent laparoscopic cholecystectomy. CONCLUSION AND RECOMMENDATIONS (1) Because of the high incidence of 52% of acalculous cholecystitis in AIDS patients with a CD4 count < 200, we recommend using intravenous cholecystokinin if the gallbladder is visualized on hepatobiliary scintigraphy in order to determine gallbladder ejection fraction and exclude acalculous cholecystitis. (2) Laparoscopic rather than open cholecystectomy should be the surgical procedure of choice in AIDS patients especially if the CD4 count is < 200.
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Affiliation(s)
- A G Cacciarelli
- Department of Medicine, St Vincent's Hospital and Medical Center of New York, Valhalla 10011, USA
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Leiva JI, Etter EL, Gathe J, Bonefas ET, Melartin R, Gathe JC. Surgical therapy for 101 patients with acquired immunodeficiency syndrome and symptomatic cholecystitis. Am J Surg 1997; 174:414-6. [PMID: 9337165 DOI: 10.1016/s0002-9610(97)00118-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hepatobiliary disease in patients with acquired immunodeficiency syndrome (AIDS) has been well documented. Cytomegalovirus and Cryptosporidium are the pathogens most frequently associated. Previous reports of cholecystectomies and AIDS have had conflicting results on morbidity and mortality. METHOD Retrospective review of 101 patients with AIDS and symptomatic cholecystitis who underwent cholecystectomy from December 1989 to May 1995. RESULTS All patients had symptoms characteristic of gallbladder disease, the most common being abdominal pain and fever. Thickening of the gallbladder was the most common diagnostic finding. Fifty-six patients underwent open cholecystectomy and 45 laparoscopic cholecystectomy. Pathologic examination revealed an abnormal gallbladder in all cases and gallstones in 29%. A specific pathogen or malignancy was identified as the etiologic agent in 44% of patients. Perioperative morbidity was similar (<5%) in both surgical groups. Perioperative mortality was 4% among all the patients treated. CONCLUSIONS Both open and laparoscopic cholecystectomy improved the quality of life of these patients and should be considered as the treatment for persistent hepatobiliary symptoms in patients with AIDS.
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Affiliation(s)
- J I Leiva
- Department of Medical Education, St. Joseph Hospital, Houston, Texas 77002, USA
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Abstract
Biliary disease occurs in a subset of AIDS patients with CD4 counts of less than 100 per mm3. These patients present with right upper quadrant and epigastric pain, cholestasis, and usually abnormal findings on imaging. In 75% of patients, an associated opportunistic infection can be identified. In patients with biliary disease, pain is often relieved following endoscopic sphincterotomy, whereas cholecystectomy provides pain relief in patients with acalculous cholecystitis.
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Affiliation(s)
- J A Nash
- Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York, USA
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Barron LG, Rubio PA. Importance of accurate preoperative diagnosis and role of advanced laparoscopic cholecystectomy in relieving chronic acalculous cholecystitis. JOURNAL OF LAPAROENDOSCOPIC SURGERY 1995; 5:357-61. [PMID: 8746986 DOI: 10.1089/lps.1995.5.357] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Between April 1, 1989, and January 1, 1994, 38 patients with chronic acalculous cholecystitis underwent an advanced (3-puncture) laparoscopic cholecystectomy at our institution. The 30 women and 8 men had a mean age of 39 years (range, 23 to 65 years) and represented 4.5% of our overall gallbladder patient population. In each case, the disease produced typical biliary colic, but no gallstones were visualized on ultrasound examination; cholecystokinin-stimulated cholescintigraphy revealed a dysfunctional gallbladder, as evidenced by an ejection fraction of < or = 35% or nonvisualization or nonemptying of the organ. In all 38 cases, cholecystectomy resulted in the complete relief of symptoms. Although an increasing number of physicians are recommending this operation for acalculous gallbladder disease, it should not be performed on the basis of clinical history alone. Rather, objective criteria confirming the need for surgical intervention should be obtained by means of appropriate preoperative testing, including cholecystokinin-stimulated cholescintigraphy.
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Affiliation(s)
- L G Barron
- Department of Surgery, Medical Center Hospital, Houston, Texas, USA
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Carroll BJ, Rosenthal RJ, Phillips EH, Bonet H. Complications of laparoscopic cholecystectomy in HIV and AIDS patients. Surg Endosc 1995; 9:874-8. [PMID: 8525437 DOI: 10.1007/bf00768881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We retrospectively evaluated the results of laparoscopic cholecystectomy in patients infected with the human immunodeficiency virus (HIV) with and without acquired immunodeficiency syndrome (AIDS). One thousand one hundred twenty-seven consecutive patients underwent laparoscopic cholecystectomy by our surgical group. Eighteen of these patients were known to be infected with the HIV virus; 6 were asymptomatic and 12 had AIDS. We reviewed the medical records of all HIV-positive individuals with regard to morbidity, mortality, and postoperative outcome following laparoscopic cholecystectomy. In the six HIV-patients without AIDS, five (83%) had improvement of symptoms postoperatively. There was one minor complication (17%). In contrast, only one of the 12 patients with AIDS had postoperative improvement of symptoms and eight (66%) had complications after surgery. There were four deaths (33%) within 30 days of surgery in this group. Only a small percentage of AIDS patients benefit from laparoscopic cholecystectomy. There is a significantly morbidity and mortality following this procedure in this group. Strategies to improve outcome are presented.
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Affiliation(s)
- B J Carroll
- Division of Minimally Invasive Surgery, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
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Sekar OR, Wynn RF, Brettle RP, Nixon SJ, Thomas JS. Gallbladder disease related to human immunodeficiency virus infection: presentation and surgical management. Br J Surg 1994; 81:1649-50. [PMID: 7827894 DOI: 10.1002/bjs.1800811128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- O R Sekar
- Department of Surgery, Western General Hospital, Edinburgh, UK
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Mdurvwa EG, Ogunbiyi PO, Gakou HS, Reddy PG. Pathogenic mechanisms of caprine arthritis-encephalitis virus. Vet Res Commun 1994; 18:483-90. [PMID: 7701786 DOI: 10.1007/bf01839425] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Goats infected with caprine arthritis-encephalitis virus (CAEV) show chronic arthritis and cachexia, which are progressive in nature. The immunopathogenic mechanisms responsible for these progressive clinical symptoms have not been fully elucidated. Various haematological and immunological parameters were evaluated in experimentally-infected goats showing typical signs of CAEV-induced disease. Infected goats showed recurrent lymphocytosis that may be due to constant presentation of antigen by infected cells of a monocyte/macrophage lineage. The serum alkaline phosphatase and gamma-glutamyl transferase concentrations were elevated in infected goats, a characteristic of hepatic and bone disorders. All other serum chemistry parameters were similar between infected and control goats. Importantly, the serum tumour necrosis factor-alpha (TNF-alpha) levels were higher in infected goats. The cachexia seen in infected goats may be at least partly due to altered metabolism as a result of prolonged elevation of serum TNF-alpha levels. Depressed natural killer cell activity was observed in infected goats and may contribute towards the establishment of a persistent infection with CAEV.
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Affiliation(s)
- E G Mdurvwa
- Department of Microbiology, School of Veterinary Medicine, Tuskegee University, Alabama 36088
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Abstract
Acute acalculous cholecystitis (AAC) is a dangerous complication of medical and surgical illnesses, and it is most commonly encountered in the intensive care setting. Although uncommon, recent reports have indicated an increasing incidence. AAC occurs most often following major trauma or nonbiliary surgical procedures, but it may be seen in conjunction with avariety ofmedical illnessesaswell. Transfusion, narcotics, mechanical ventilation, total parented nutrition, and sepsis have been associated with AAC, but it is likely that ischemic injury to the gallbladder is the most important pathogenetic factor. Primary infection of the biliary tract is not an important factor in the development of AAC, except in the acquired immunodeficiency syndrome. The incidence of gangrene and perforation is high in AAC in contrast to acute calculous choleqstitis. The clinical presentation may be highly variable; thus, a high index of suspicion is required for diagnosis. Fever, leukocytosis, and right upper quadrant tenderness are the most common findings. Early ultrasonography is appropriate when AAC is suspected, although computed tomography and cholescintigraphy may be useful in selected patients. Delay in diagnosis longer than 48 hours is associated with a perforation rate of 40%. Urgent cholecystectomy is the preferred treatment, but percutaneous cholecystostomy is an acceptable alternative in patients unable to withstand surgery.
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Affiliation(s)
- David T. Walden
- University of Texas Medical Branch, Division of Gastroenterology, Department of Internal Medicine, Galveston, TX
| | - Fernando Urrutia
- University of Texas Medical Branch, Division of Gastroenterology, Department of Internal Medicine, Galveston, TX
| | - Roger D. Soloway
- University of Texas Medical Branch, Division of Gastroenterology, Department of Internal Medicine, Galveston, TX
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Shirai Y, Tsukada K, Kawaguchi H, Ohtani T, Muto T, Hatakeyama K. Percutaneous transhepatic cholecystostomy for acute acalculous cholecystitis. Br J Surg 1993; 80:1440-2. [PMID: 8252358 DOI: 10.1002/bjs.1800801129] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The effectiveness and long-term results of percutaneous cholecystostomy for acute acalculous cholecystitis are evaluated. Fifteen patients with acute acalculous cholecystitis were treated prospectively by this procedure, using a pigtail catheter successfully placed under ultrasonographic and fluoroscopic guidance. Prompt relief of the signs and symptoms of cholecystitis was achieved in 14 patients. One required emergency cholecystectomy for uncontrolled bleeding after drainage. Another patient underwent prophylactic cholecystectomy before further chemotherapy for leukaemia. The remaining 13 patients required no further surgery. Morbidity and mortality rates were 13 per cent and nil respectively. Long-term follow-up showed no recurrence of cholecystitis after removal of the catheter. Percutaneous cholecystostomy is a safe, effective and usually definitive procedure for the treatment of acute acalculous cholecystitis.
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Affiliation(s)
- Y Shirai
- Department of Surgery, Niigata University School of Medicine, Japan
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Sanchez-Urdazpal L, Gores GJ, Ward EM, Maus TP, Wahlstrom HE, Moore SB, Wiesner RH, Krom RA. Ischemic-type biliary complications after orthotopic liver transplantation. Hepatology 1992; 16:49-53. [PMID: 1618482 DOI: 10.1002/hep.1840160110] [Citation(s) in RCA: 291] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Nonanastomotic biliary strictures that involve only the biliary tree of the graft occur after orthotopic liver transplantation in patients with hepatic artery thrombosis, chronic ductopenic rejection and ABO blood group incompatibility. This complication may also occur in the absence of these known risk factors. The major focus of our study was to evaluate the risk factors for nonanastomotic biliary stricturing of unknown cause after orthotopic liver transplantation. Results demonstrate that the development of biliary strictures is strongly associated with the duration of cold ischemic storage of allografts in both Euro-Collins solution and University of Wisconsin solution. Results also demonstrate that strictures are not associated with the type of biliary reconstruction, the primary liver disease, cytomegalovirus infection, allograft rejection or the presence of a positive lymphocytotoxic crossmatch. More recently, we have markedly reduced the occurrence of nonanastomotic biliary stricturing by decreasing the ischemia time of our allografts. Thus nonanastomotic biliary strictures appear to be the result of the ischemia/reperfusion-induced tissue injury associated with the harvest and implantation of allografts.
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Affiliation(s)
- L Sanchez-Urdazpal
- Section of Transplantation Surgery, Mayo Clinic, Rochester, Minnesota 55905
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Vilgrain V, Erlinger S, Belghiti J, Degott C, Menu Y, Nahum H. Cholangiographic appearance simulating sclerosing cholangitis in metastatic adenocarcinoma of the liver. Gastroenterology 1990; 99:850-3. [PMID: 2379788 DOI: 10.1016/0016-5085(90)90979-b] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Three patients with liver metastases and clinical and biochemical signs of cholestasis are reported in this study. In the three patients, cholangiography showed shifted and stretched intrahepatic bile ducts and multifocal strictures simulating intrahepatic primary sclerosing cholangitis. In two patients, histological examination showed periductal fibrosis or inflammation. Hepatic metastases should be included among the conditions considered to simulate intrahepatic primary sclerosing cholangitis during cholangiography.
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Affiliation(s)
- V Vilgrain
- Service de Radiologie, Hôpital Beaujon, Clichy, France
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