Acalculous hemorrhagic cholecystitis is a rare complication of acute cholecystitis and is associated with a high mortality rate. We present a case of acalculous hemorrhagic cholecystitis with hematoma in the gallbladder lumen, which was diagnosed using magnetic resonance imaging (MRI). The T1- & T2-weighted MRI revealed gallbladder distension with a hypointense intraluminal hematoma. The excellent tissue contrast provided by MRI is useful for detecting hematomas in the cases of hemorrhagic cholecystitis.
Acalculous Cholecystitis ; Cholecystitis ; Cholecystitis, Acute ; Gallbladder ; Hematoma ; Magnetic Resonance Imaging

No abstract available.
Cholecystitis, Acute ; Constriction, Pathologic ; Stents

Limy bile is a relatively rare condition in which a radiopaque material is visible in the gallbladder, extending rarely into the bile duct, on plain radiography. Acute cholangitis or cholecystitis caused by limy bile is a very rare condition. There are no definite treatment guidelines for limy bile, but in most cases with cholangitis or cholecystitis, laparoscopic cholecystectomy has been the preferred treatment. We report a case of limy bile with biliary symptoms that was treated only with an endoscopic procedure.
Bile ; Bile Ducts ; Cholangitis ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Gallbladder

To assess the pathological basis of the sonographic changes of the gallbladder wall in cholecystitis, thesonographic appearances of the gallbladder wall were analysed in 17 patients with acute cholecystitis and 27patients with chronic cholecystitis, and correlated with pathological specimens removed at surgery. In acutecholecystitis, a thin sonolucent layer within the echogenic gallbladder wall corresponds to subserosal edema,hemorrhage and inflammatory cell infiltration: in chronic cholecystitis it corresponds to subserosal edema,hemorrhage and inflammatory cell infiltration: in chronic cholelcystitis it corresponds to subserosal edema,hemorrhage and inflammatory cell infiltration, in chronic cholelcystitis it corresponds to muscular hypertrophy.Indistinctness and/or a low echogenicity rind along the inner margin reflects mucosal sloughing or obliteration ofthe mucosal folds. Uniformly decreased echogenicity of the wall is caused by severe inflammatory cell infiltrationwith sloughing of the mucosa or obliteration of the mucosal folds. These sonographic singns are considered to bevaluable sings of cholecystitis.
Cholecystitis ; Cholecystitis, Acute ; Gallbladder ; Humans ; Mucous Membrane ; Ultrasonography

Gangrenous cholecystitis is a kind of acute cholecystitis, whose course of disease progresses rapidly, early diagnosis is difficult and mortality is high, and clinicians are prone to misdiagnosis and missed diagnosis in clinical work.However, gangrenous cholecystitis has been ignored in various guidelines.This paper systematically summarized the pathogenesis, pathological manifestations, epidemiology, clinical diagnosis and treatment of gangrenous cholecystitis, hoping to provide a complete and clear diagnosis and treatment process for clinicians.
Cholecystectomy ; Cholecystitis/surgery* ; Cholecystitis, Acute/surgery* ; Gangrene/surgery* ; Humans

Emphysematous cholecystitis is an uncommon form of acute cholecystitis characterized by the presence of gas within the wall, lumen of the gall bladder or biliary ducts. Clinically it is very similar to ordinary farm. But since the risk of perforation is five times that expected from ordinary cholecystitis, early diagnosis and appropriate surgical treatment are important. We could diagnose these cases by the simple abdomen, abdominal ultrasound and abdominal CT by the presence of air in the lumen and the wall of the gall bladder. Percutaneous trans hepatic gall bladder drainage (PTGBD) for decompression was used because poor general condition of patients and later, we could successfully perform the cholecystectomy without any complication. We presented two cases of emphysematous cholecystitis with review of the relevant literature on the subject.
Abdomen ; Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute ; Decompression ; Drainage ; Early Diagnosis ; Emphysematous Cholecystitis* ; Humans ; Tomography, X-Ray Computed ; Ultrasonography ; Urinary Bladder

PURPOSE: Operative management of acute cholecystitis in aged patients has been shown to have relatively higher morbidity and mortality. The aim of this study was to determine appropriate management protocols for acute cholecystitis in those more than 70 years old. METHODS: From May 2003 to Dec 2009, we performed this study of patients over 70 years old that were diagnosed with acute cholecystitis (n=257). We excluded patients that had a hepatobilliary malignancy, a previous laparotomy history, secondary cholecystitis, or a high operative risk factor (n=78). Eligible participants were divided into two groups according to the first management of acute cholecystitis. One hundred two of the 179 (group A) had undergone a laparoscopic cholecystectomy (LC) or open cholecystectomy (OC) within 48 hr after arriving at the emergency room; 77 of the 179 (group 2) had PTGBD done as the first management protocol. We divided group 2 into group C (n=47) and D (n=30) according to cholecystectomy or not. We compared clinical outcomes of the two groups. RESULTS: The mean age of patients was 77.5 years old (102 for Group A and 77 for Group B. Univariant analysis of pre-operative clinical findings between groups A and B showed a significant difference only in age and in type of acute cholecystitis, However, the pre-operative co-morbidity of group B was significantly higher than that for group A. Comparing postoperative results between groups A and C, postoperative complications, open conversion rate, and mortality after cholecystectomy were not significantly different. CONCLUSION: PTGBD could be considered as appropriate management in aged patients with acute cholecystitis. Moreover, PTGBD can reduce unnecessary cholecytectomies.
Aged ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Drainage ; Emergencies ; Gallbladder ; Humans ; Laparotomy ; Postoperative Complications ; Risk Factors

PURPOSE: This study was to evaluate the safety and conversion rate of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD) in patients with a complicated acute cholecystitis (GB empyema, gangrenous cholecystitis and pericholecystic abscess) according to the timing of LC. METHODS: One hundred and four patients, who underwent a laparoscopic cholecystectomy after PTGBD between March 2004 and December 2006, were analyzed. Thirty-four patients underwent LC within 7 days after PTGBD (early group, n=34) and 38 patients underwent LC between 14 and 39 days after PTGBD (delayed group, n=38). Thirty-two patients were excluded because of gallbladder cancer (n=2), simple acute cholecystitis (n=12), a history of previous abdominal surgery (n=5), and LC between 8 and 13 days after PTGBD (n=13). RESULTS: There was no significant difference in age (early group, 58.4+/-11.2; delayed group, 61.0+/-12.1), diagnosis, duration of symptoms, WBC counts, interval of admission and PTGBD, improvement of symptoms after PTGBD, American Society of Anesthesiologists (ASA) score, prior medical history, post-PTGBD and postoperative complications, and operation time. The rate of conversion to an open laparotomy was 14.7% (5/34) in the early group and 2.6% (1/38) in the delayed group (statistically not significant). CONCLUSION: The timing of LC after PTGBD for a complicated acute cholecystitis does not influence the rate of conversion to an open laparotomy, surgery time and complication. However, a delayed LC after PTGBD tends to decrease the rate of conversion to an open laparotomy.
Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cholecystitis, Acute* ; Diagnosis ; Drainage* ; Empyema ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Laparotomy ; Postoperative Complications

PURPOSE: Acute cholecystitis has been a general contraindication of laparoscopic cholecystectomy, and complicated cholecystitis is a challenging disease even in open surgery. The purpose of this study is to evaluate the effectiveness and safety of laparoscopic cholecystectomy in acute and complicated cholecystitis. METHODS: We retrospectively reviewed the medical records of 233 cases treated with laparoscopic cholecystectomy for acute and complicated cholecystitis at Ewha Mokdong hospital from March 1997 to February 2001. Postoperative outcomes were compared between simple acute cholecystitis and complicated cases. The uncomplicated simple acute cholecystitis group (simple acute group) comprised 161 cases (69%) and the complicated cholecystitis group, which included hydrops, empyema, and pericholecystic abscess (complicated group), included 72 cases (31%). RESULTS: In the acute and complicated cholecystitis groups, the length of postoperative diet was 2.19 days and 2.46 days, the conversion rate was 8.07% and 8.3%, and the complication rate was 4.97% and 12.5%, respectively. There was no statistical difference for these three factors (p>0.05). The hospital stay was 6.19 days and 7.57 days, and the mean time of operation was 97.09 minute and 116.5 minute, respectively. These two factors were significantly different (p<0.05). CONCLUSION: Laparoscopic cholecystectomy was shown to be a safe and effective treatment for simple acute cholecystitis and complicated acute cholecystitis. Even in severecomplicated cholecystitis, laparoscopic cholecystectomy can be a primary treatment modality.
Abscess ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cholecystitis, Acute* ; Diet ; Edema ; Empyema ; Length of Stay ; Medical Records ; Retrospective Studies

Gastric cancer mainly spreads to the liver, peritoneum, and lymph nodes and rarely metastasizes to the gallbladder. The prognosis of gastric cancer with metastasis to the gallbladder is reported to be very poor, and presentation with cholecystitis is a prognostic factor. Herein, we present a case of gastric cancer with metastasis to the gallbladder, accompanied by acute cholecystitis.
Cholecystitis ; Cholecystitis, Acute* ; Gallbladder* ; Liver ; Lymph Nodes ; Neoplasm Metastasis* ; Peritoneum ; Prognosis ; Stomach Neoplasms*