Endoscopic gallbladder drainage (EGBD) has been used to treat acute cholecystitis or to relieve malignant biliary obstruction as an alternative to percutaneous gallbladder drainage and patient's are poor surgical candidates. This is currently being performed by placement of lumen apposing metallic stent (LAMS) with electrocautery mounted tip delivery system also called as “hot” technique. We had reported a case of self-expanding metallic stent (SEMS) within LAMS after stent migration during EGBD using “hot” technique and propose routine use of guidewire in patients undergoing the procedure.
Cholecystitis, Acute ; Cholelithiasis ; Drainage ; Electrocoagulation ; Endoscopy ; Gallbladder ; Humans ; Stents ; Ultrasonography

Despite the improved accuracy and increasing use of prenatal ultrasonography, fetal cholelithiasis is a rarely detected disease, and its natural history and clinical significance are not yet well defined. Many maternal and neonatal risk factors are associated with fetal cholelithiasis. Intrahepatic cholestasis of pregnancy could be a risk factor for fetal cholelithiasis, but no case reports in previous literatures have demonstrated this relationship. We present a case of fetal cholelithiasis in the late third trimester of pregnancy that was related to intrahepatic cholestasis of pregnancy, along with a brief review of associated literatures.
Cholelithiasis* ; Cholestasis, Intrahepatic* ; Female ; Humans ; Natural History ; Pregnancy Trimester, Third ; Pregnancy* ; Risk Factors ; Ultrasonography ; Ultrasonography, Prenatal

Agenesis of the right lobe of the liver is an extremely rare anomaly of the liver, and few cases are reported in the literature. Most of the patients with this anomaly are accompanied by additional anormalies such as retrohepatic or suprahepatic gallbladder and other biliary tract diseases, including cholelithiasis, carcinoma of the gallbladder and portal hypertension. The diagnosis of this rare anatomical variant was established by ultrasonography and computed tomography. The radiological findings, clinical presentation, and differential diagnosis are reviewed.
Biliary Tract Diseases ; Cholelithiasis ; Diagnosis ; Diagnosis, Differential ; Gallbladder ; Humans ; Hypertension, Portal ; Liver* ; Ultrasonography

Various complications following laparoscopic cholecystectomy have been reported. We describe a case of intraabdominal abscess formation which was developed two months after the inadvertently spilling of gallstones laparoscopic cholecystectomy in a patient with acute cholelithiasis. The condition was initially found on computed tomography and the diagnosis was confirmed with ultrasound. Although this is a rare complication of laparoscopic cholecystectomy, the spilling of gallstones should be recognized as a potential source of intra-abdominal abscess formation even in a patient presenting months after laparoscopic cholecystectomy. We suggest that routine use of the specimen retrieval bag is highly recommended especially for beginners of laparoscopic cholecystectomy during their initial learning period.
Abdominal Abscess ; Abscess* ; Cholecystectomy, Laparoscopic* ; Cholelithiasis ; Diagnosis ; Gallstones* ; Humans ; Learning ; Postoperative Complications ; Ultrasonography

PURPOSE: The purpose of this study is to determine for upper abdominal pain, the accuracy of emergency abdominal ultrasonography (EAU) performed by emergency physicians with limited training. METHODS: Two PGY-3 emergency physicians, who had received 2 hours of hands-on training, including the normal anatomy of a biliary system, liver, kindney, spleen, and pancreas, and who had studied the pathologic findings for another month were the subjects of this study. They used a Sonosite 180 R to perform EAU on patients with upper abdominal pain within 2 months after training. We determined the agreement between the radiologist 's abdominal ultrasonography(RAU) and EAU by using Kappa statistics. RESULTS: A total of 59 patients were enrolled. The agreement between the EAU and the RAU findings was 0.97, 0.88, 0.79, 0.73, 0.62, and 0.57 for gall bladder (GB) distension, cholelithiasis, GB wall thickening, duct dilatation, choledocholithiasis, and pericholecystic fluid, respectively (p<0.05). CONCLUSION: The results of EAU, performed by emergency physician with limited training on patients suffering from upper abdominal pain had a significant agreement with the RAU. However, more educations and cautions are warranted for diagnosing pericholecystic fluid and choledocholithiasis.
Abdominal Pain ; Biliary Tract ; Choledocholithiasis ; Cholelithiasis ; Dilatation ; Emergencies* ; Humans ; Liver ; Pancreas ; Spleen ; Ultrasonography* ; Urinary Bladder

This is a review of gastric resection surgeries that were carried out in 570 patients with stomach cancer who were admitted to Kyung Hee University Hospital from January, 1989 through December, 1993. In order to establish the incidence of cholelithiasis after gastric resection, patients was examined with abdominal ultrasonography preoperatively and postoperatively. The prevalence of cholelithiasis at admission was 4.6%. Study candidates consisted of 366 patients, except those who had cholelithiasis preoperatively and who didn't have a follow-up after gastric resection. Cholelithiasis after gastric resection developed in 16.4%(60/366) of patients, and which was significantly higher than incidence of cholelithiasis at admission(p<0.05). The incidence of cholelithiasis was not related significantly to the sex or age of the patients(p>0.05). In 51.6%(31/60) of patients, cholelithiasis have developed within 1 year after operation. The incidence of cholelithiasis after total gastrectomy with esophagojejunostomy(21.8%) was higher than subtotal gastrectomy with gastrojejunostomy(15.3%) or with gastroduodenostomy(14.3%), but it was not shown to be a statistical difference(p>0.05). There was no relation between the incidence of cholelithiasis and the stage of the stomach cancer. Four of the sixty patients presenting cholelithiasis underwent cholesystectomy because of significant billiary symptoms. In conclusion, cholelithiasis appears to be a frequent complication after gastrectomy. It may be related to the vagotomy which is performed at the time of gastric resection.
Cholelithiasis* ; Follow-Up Studies ; Gastrectomy ; Humans ; Incidence ; Prevalence ; Stomach Neoplasms* ; Stomach* ; Ultrasonography ; Vagotomy

BACKGROUND: In solid organ transplantation patients, complications of cholelithiasis may run a fulminant course, resulting in high morbidity and mortality under immunosuppression and may even result in rejection. Here, we reviewed medical records of 66 patients in order to determine the outcome of management approach for asymptomatic gallstones in renal transplantation patients. METHODS: We retrospectively reviewed clinical courses of 66 cases of renal transplantation performed between 2000 and 2012 at Kosin University Gospel Hospital. RESULTS: Among 66 cases, eight had gallstones before transplantation. Three of these cases had undergone previous cholecystectomy for symptomatic gallstones, one had a simultaneous laparoscopic cholecystectomy and renal transplantation, and four were observed by regular abdominal ultrasonography. One patient was found to have cholangitis, and endoscopic retrograde biliary drainage was performed, resulting in alleviation of symptoms. Among 58 cases without preoperative gallstones, three developed gallstones after transplantation. One patient had cholecystitis, and the symptoms subsided after conservative treatment. CONCLUSIONS: For patients with asymptomatic gallstones who are awaiting renal transplantation, expectant management should be considered.
Cholangitis ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholelithiasis ; Drainage ; Gallstones* ; Humans ; Immunosuppression ; Kidney Transplantation* ; Medical Records ; Mortality ; Organ Transplantation ; Retrospective Studies ; Transplants ; Ultrasonography

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

We report a case of a 52-year-old man in whom a cystic pancreatic tumor was successfully removed by laparoscopic enucleation. The patient had a followup CAT-scan for a resolving right upper lobe pneumonia which demonstrated a unilocular hypodense 3.9x2.2 cm sized cyst in the uncinate process of the pancreas. He had a laparoscopic biliopancreatic diversion with duodenal switch in July 2002, and also had laparoscopic cholecystectomy for cholelithiasis in December 2003. Laparoscopic intraoperative ultrasonography revealed a solitary cystic tumor in the inferior portion of pancreatic head. Laparoscopic enucleation of the tumor was performed using Ultracision(R) between the cyst outer wall and the normal pancreatic parenchyma. The operative time was 160 minutes, the estimated blood loss was 20 ml, and there were no perioperative complications. The patient's postoperative course was uneventful, and he was discharged on the first postoperative day. The histopathologic diagnosis showed a mucinous cystadenoma. We reported a new technique for safe management of small cystic tumors located on surface of the pancreas.
Biliopancreatic Diversion ; Bone Cysts ; Cholecystectomy, Laparoscopic ; Cholelithiasis ; Cystadenoma, Mucinous* ; Diagnosis ; Follow-Up Studies ; Head ; Humans ; Laparoscopy ; Middle Aged ; Mucins* ; Operative Time ; Pancreas ; Pancrelipase ; Pneumonia ; Ultrasonography

Cholelithiasis in infancy is a rare disorder. A number of conditions that occur in the neonatal period predispose to the development of cholelithiasis. Cholelithiasis is more marked in the premature than adult, because of the immaturity of the enterohepatic circulation of bile acids which renders the newborn more susceptible to the cholestatic effect of total parenteral nutrition (TPN). Parenteral nutrition associated cholelithiasis is the major indication for cholecystectomy in the pediatric age group because of severe complication, but a number of recent studies report spontaneous resolution of the stones. We report a case of a female infant with cholelithiasis diagnosed by ultrasonogram at 88 days of age which is probably induced by prolonged lack of enteral feeding and TPN.
Adult ; Bile Acids and Salts ; Cholecystectomy ; Cholelithiasis* ; Enteral Nutrition* ; Enterohepatic Circulation ; Female ; Humans ; Infant ; Infant, Newborn ; Parenteral Nutrition ; Parenteral Nutrition, Total* ; Ultrasonography