Backgrounds: cholecystitis is a common disease in surgery. The rate of acute cholecystitis alone without gall stones in the literature is approximately 50-10% of all acute cholecystitis. In Vietnam, this prevalence is very high, up to 47% of acute cholecystitis alone and the disease is common in people over age 50, with a history of hypertension. Objectives: to descript clinical, paraclinical features, and results of acute cholecystitis surgical treatment (open surgery and laparoscopic surgery) in the elderly at Viet Duc Hospital. Subjectives and Method: a cross-sectional study was carried out on 119 patients aged 60 or older diagnosed with acute cholecystitis, was operated at the Viet Duc hospital from January 2006 to July 2006. Status of body organs was assessed by classification of the American Society of Anesthesiologists (ASA). Results: cholecystitis in the elderly was mainly caused by chronic inflammation due to stone (88.2%). The rate of acute inflammation accounts for 11.8%. Female (63.9%). The most commonly age group was from 60-69 years old. Scheduled surgery accounts for 75.6%, emergency surgery 24.4%. Open surgery accounted for 11.8%, laparoscopic surgery accounted for 84%. Earlier results: good 87.4%, average 8.4%, poor 4.2%. Results after 3 months: good result accounted for 88.7%. Conclussion: cholecystitis in the elderly was mainly caused by chronic inflammation due to stone. Surgical treatment was generally good results (including early and late results).
Cholecystitis/ pathology ; surgery ;

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

Acute cholecystitis after cardiac surgery is rare but carries a high mortality. Intraaortic balloon pump (IABP) is effective and useful device for mechanical assistance for heart. We reported a case of 34-year-old patient who had experienced pulmonary hypertension and right ventricular failure during cholecystectomy for acute cholecystitis after cardiac surgery. Thus, the patient was mechanically supported with IABP and hemodynamics and cardiac function were improved.
Adult ; Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute ; Heart ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Thoracic Surgery

Adult ; Cholecystectomy, Laparoscopic ; Cholecystitis ; surgery ; Female ; Humans ; Lactation ; physiology

No abstract available.
Cholecystitis, Acute/*surgery ; Drainage/*methods ; Endoscopy, Gastrointestinal/*methods ; Female ; Gallbladder/*surgery ; Humans ; Male

No abstract available.
Cholecystitis, Acute/*surgery ; Drainage/*methods ; Endoscopy, Gastrointestinal/*methods ; Female ; Gallbladder/*surgery ; Humans ; Male

Adult ; Cholecystectomy, Laparoscopic ; methods ; Cholecystitis ; complications ; surgery ; Female ; Gallstones ; complications ; surgery ; Humans ; Treatment Outcome

PURPOSE: Xanthogranulomatous cholecystitis_(XGC) is an unusual and destructive inflammatory process of the gallbladder and it's characterized by severe proliferative fibrosis. XGC usually presents with features of chronic cholecystitis or acute cholecystitis, yet clinically, radiologically and macroscopically, XGC may be difficult to differentiate from gallbladder cancer. The purpose of our study was to evaluate the radiologic features of XGC and their correlation with the clinical, pathologic and surgical findings. METHODS: We performed retrospective analysis on 14 cases of XGCs that were operated on between March 1999 and December 2005. The clinical features, preoperative radiologic findings, operative findings and postoperative courses were reviewed. RESULTS: Fourteen cases of XGC were found among 1451 cases of cholecystectomy (0.96%). Mirizzi's syndrome was observed in 35.7% of the patients. Cholelithiasis and a thickened gallbladder wall were frequent findings. The most characteristic CT finding was hypodense intramural nodule like microabscess, and this was seen in 42.8% of the patients. The most characteristic sonographic finding was the presence of hypoechoic nodule in the gallbladder wall, and this was seen in 55.5% of the patients. 9 patients underwent open cholecystectomy including one case of T-tube choledocholithotomy. Four of five patients who underwent laparoscopic cholecystectomy required conversion to open surgery. A malignant lesion was suspected preoperatively in two cases, and both underwent frozen biopsy during surgery. CONCLUSIONS: Although the preoperative diagnosis of XGC is difficult, the presence of hypodense intramural nodule on CT or hypoechoic nodule in the gallbladder wall on sonography is highly suggestive of XGC. As XGC may resemble malignancy, differentiation is essential, via intraoperative frozen biopsy to deliver the optimal surgical treatment.
Biopsy ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis* ; Cholecystitis, Acute ; Cholelithiasis ; Conversion to Open Surgery ; Diagnosis ; Fibrosis ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Mirizzi Syndrome ; Retrospective Studies ; Ultrasonography

PURPOSE: Laparoscopic cholecystectomy (LC) has replaced open cholecystectomy (OC) for the majority of patients. However, a minority of patients still require conversion to open cholecystectomy during the perioperative period. This study was designed to determine the contributing factors related to conversion to open cholecystectomy. METHODS: The data from 3,510 laparoscopic cholecystectomies, performed at Chung-Ang university hospital from September 1990 to June 2001, were reviewed retrospectively. Pre-operative laboratory data, post-operative pathologic findings, complications, and the reasons for conversion to open cholecystectomy were evaluated. RESULTS: Sixty six (1.88%) of 3,510 patients were converted to open surgery, due to bleeding (39%), adhesion (26%), bile duct injury (23%) and inflammation (6%). These conversion cases were more prevalent in males and needed longer hospital stay. Thickening of the gallbladder wall and gangrenous cholecystitis were frequent pathologic findings among the conversion cases. CONCLUSION: Thickening of the gallbladder wall, inflammation and anatomical variation of the gallbladder were important factors for conversion to open surgery. Thus, these predictive findings allow the surgeons to preoperatively discuss the higher risk of conversion and allow for an earlier judgement and decision on conversion if intraoperative difficulty is encountered.
Bile Ducts ; Cholecystectomy* ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Conversion to Open Surgery ; Gallbladder ; Hemorrhage ; Humans ; Inflammation ; Length of Stay ; Male ; Perioperative Period ; Retrospective Studies

PURPOSE: Laparoscopic cholecystectomy has been performed even in case of acute cholecystitis and GB empyema with increasing experience of laparoscopic surgery. Many previous studies has been recommended early laparoscopic cholecystectomy in acute cholecystitis. METHODS: From February, 1997 to January, 2000, 364 patients were attempted to laparoscopic cholecystectomy and 71 patients of them were attempted to laparoscopic cholecystectomy due to acute cholecytitis. They were divided into 4 groups based on the time of operation form the onset of symptom. These groups were compared in conversion rate and postoperative clinical outcomes, such as operation time, time of bowel movement, starting diet, starting soft diet and discharge. The affecting factors on conversion were analyzed (age, sex, fever, murphy sign, accompanying pancreatitis, SGOT/SGPT, alkaline phosphatase, GB wall thickening, WBC count). RESULTS: Among 71 patients who were attempt to laparoscopic cholecystectomy in acute cholecystitis, 20 patients (28.1%) required converting to open surgery. There were no statistically significant difference in clinical outcomes and conversion rate between four groups (p>0.568). In univariate analyis, high frequency of conversion to open surgery in acute cholecystitis was observed in male (p=0.012). CONCLUSION: Even though conversion rate to open surgery is still high in acute cholecystitis, the time of laparoscopic surgery in acute cholecystits does not affect on the conversion rate and postoperative clinical outcomes. Considering of the hospital stay and its related economic problems, laparoscopic cholecystectomy should be attempted as soon as possible without hesitation. It may be due to advanced laparoscopic techniques and experiences.
Alkaline Phosphatase ; Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute* ; Conversion to Open Surgery ; Diet ; Empyema ; Fever ; Humans ; Laparoscopy ; Length of Stay ; Male ; Pancreatitis