Thickening of the gallbladder wall is a relatively frequent finding on diagnostic imaging. Such thickening is also a common but nonspecific finding in many patients with intrinsic gallbladder disease and extracholecystic conditions. Wall thickening may be diagnostically problematic, occurring (as it does) in both symptomatic and asymptomatic patients and in those with and without indications for cholecystectomy. An important first step is to distinguish between the diffuse and focal forms of thickening. Subsequently, identification of ancillary imaging findings and the directed use of additional imaging modalities allow accurate diagnosis. This is of clinical importance. Misinterpretation of the cause of thickening can trigger unnecessary cholecystectomies in patients without intrinsic gallbladder disease. Also, misdiagnosis of patients who do in fact require cholecystectomy may delay treatment, thus increasing morbidity. Although a definitive imaging diagnosis may not be possible, the cause of gallbladder wall thickening can be determined in most instances by correlating the clinical presentation with associated imaging findings.
Cholecystectomy ; Diagnosis ; Diagnostic Errors ; Diagnostic Imaging ; Gallbladder Diseases ; Gallbladder* ; Humans

Although the ultrasonography has been regarded as a main procedure in the diagnosis of gallbladder diseases, no many papers concerning the ultrasonographic findings of gallbladder empyema appeared in the literature. Twenty-four cases of surgically proven gallbladder empyema were studied by ultrasonography in our hospital during last 15 months. The results were as follows; 1. The size of gallbladder was enlarged in 18 cases. 2. The thicknessof gallbladder wall was more than 3mm in 16 cases. 3. The echogenicity of gallbladder wall was diminished in all cases. the inner margin of gallblaldder wall was also ill-defined in all cases. These findings are considered to be important in the diagnosis of gallbladder empyema. 4. The internal echogenicity of gallbladder (diffuse or localized) was positive in 16 cases and negative in the remainders. The echo genility was thought to beproportional to the amount of pus in gallbladder. 5. The 7 cases presented periocholecystic sonolucent area hadperforation of gallbladder and pericholecystic abscess. 6. Gallstone was found in 17 cases.
Abscess ; Cholecystitis ; Diagnosis ; Gallbladder Diseases ; Gallbladder ; Gallstones ; Suppuration ; Ultrasonography

It is essential to estimate the size, volume and wall thickness of the gallbladder in diagnosis of the gallbladder disease. Author measured maximum length, A-P diameter, width, wall thickness and volume of gallbladder ultrasonographically in 130 normal adults. The results are as follows; 1. The mean length of the gallbladder was 5.88±0.97 cm. 2. The mean A-P diameter of the gallbladder was 2.49±0.52c, on longitudinal scan and 2.48±0.42cm on coronal scan. 3. The mean width of the gallbladder was 2.48±0.46cm. 4. The mean wall thickness of thegallbladder was 2.09±0.29mm. 4. The mean volume of gallbladder was 27.09±10.07cm² by single cylinder method and 18.27±9.04cm³ by Weill method, but there was linear correlation between the two methods(p<0.001).
Adult ; Diagnosis ; Gallbladder Diseases ; Gallbladder ; Humans ; Methods ; Ultrasonography

Adult ; Choristoma ; diagnosis ; Gallbladder Diseases ; diagnosis ; Humans ; Liver ; Male

The combined diagnostic modalities using abdominal ultrasound, endoscopic ultrasound and endascopic retrograde cholangiopancreatogram are useful for the diagnosis of gall bladder disease. But, these diagnostic methods have limitations for the detection of early flat-type gallbladder cancer. To cope with these problems, double contrast study of gallbladder disease is being recently used to diagnose the flat-type cancer of gallbladder in Japan. Herein we report a case of chronic cholecystitis confirmed histologically and assisted by double contrast method of gallbladder, which was diagnosed as a gallbladder polyp by abdominal sonogram at first. The method requires the cystic duct cannulation and placement of the catheter to the gallbladder. And then Barium sulfate and CO2 are injected through the catheter. The patient didnt experience any complication during and after this procedure except for hyperamylasemia. After the simple cholecystectomy, he improved completely. In conclusion, double contrast study of gallbladder can be useful in the diagnosis of the gallbladder disease and compensate for the other dignostic tools.
Barium Sulfate ; Catheterization ; Catheters ; Cholecystectomy ; Cholecystitis* ; Cystic Duct ; Diagnosis ; Gallbladder Diseases ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Hyperamylasemia ; Japan ; Polyps ; Ultrasonography

With the developement of the conventional abdominal ultrasound, many asymptomatic gallbladder diseases are noted. The combined diagnostic modalities using abdominal ultrasound, endoscopic ultrasound and endoscopic retrograde cholangiopanereatography are useful for the diagnosis of gallbladder diseases, especially polypoid lesions. But, diagnostic accuracy or ability is not satisfactory for the detection of early gallbladder cancer, among which there are increasing trends of flat or superficial type. Many efforts were tried to diagnose these lesions through the variable methods by direct access to the gallbladder, such as percutaneous transhepatic cholecystoscopy(PTCCS). With the advent of cystic duct cannulation method, endoscopic cholecystoduodenal stenting or nasocholecystic drainage come to be available for the treatment of acute suppurative cholecystitis. Via this route, double contrast study with barium sulfate and CO2 showed fine reticular mucosal structures of the gallbladder and increased diagnostic accuracy af the flat type cancer. We report 2 cases of gallbladder diseases with early cancer confined to the mucosa and adenomyomatous hyperplasia. They were diagnosed by the double contrast method of gallbladder that was firstly introduced domestically by us after endoscopic cannulation of cystic duct and pla~eement of the catheter to the gallbladder.
Barium Sulfate ; Catheterization ; Catheters ; Cholecystitis ; Cystic Duct ; Diagnosis ; Drainage ; Gallbladder Diseases* ; Gallbladder Neoplasms ; Gallbladder* ; Hyperplasia ; Mucous Membrane ; Stents ; Ultrasonography

With the developement of the conventional abdominal ultrasound, many asymptomatic gallbladder diseases are noted. The combined diagnostic modalities using abdominal ultrasound, endoscopic ultrasound and endoscopic retrograde cholangiopanereatography are useful for the diagnosis of gallbladder diseases, especially polypoid lesions. But, diagnostic accuracy or ability is not satisfactory for the detection of early gallbladder cancer, among which there are increasing trends of flat or superficial type. Many efforts were tried to diagnose these lesions through the variable methods by direct access to the gallbladder, such as percutaneous transhepatic cholecystoscopy(PTCCS). With the advent of cystic duct cannulation method, endoscopic cholecystoduodenal stenting or nasocholecystic drainage come to be available for the treatment of acute suppurative cholecystitis. Via this route, double contrast study with barium sulfate and CO2 showed fine reticular mucosal structures of the gallbladder and increased diagnostic accuracy af the flat type cancer. We report 2 cases of gallbladder diseases with early cancer confined to the mucosa and adenomyomatous hyperplasia. They were diagnosed by the double contrast method of gallbladder that was firstly introduced domestically by us after endoscopic cannulation of cystic duct and pla~eement of the catheter to the gallbladder.
Barium Sulfate ; Catheterization ; Catheters ; Cholecystitis ; Cystic Duct ; Diagnosis ; Drainage ; Gallbladder Diseases* ; Gallbladder Neoplasms ; Gallbladder* ; Hyperplasia ; Mucous Membrane ; Stents ; Ultrasonography

Gallbladder agenesis is a rare condition of hepatobiliary congenital anomaly. It is caused by failure of development of the caudal division of the primitive hepatic diverticulum or failure of vacuolization after the solid phase of embryonic development. It is divided into 2 groups: (1) those whose conditions are discovered clinically because of persistent symptoms and proven by abdominal exploration with operative cholangiography; and (2) those who are asymptomatic during life and whose conditions are discovered only at necropsy. If symptoms are present, they are unlikely to be related to gallbladder disease. It is impossible, at present, to make a preoperative diagnosis of gallbladder agenesis. Operative cholangiography is absolutely necessary to rule out an intrahepatic gall bladder. Confirmation at surgery and autopsy requires thorough dissection of the biliary tract and liver bed. Therefore, we presented this case with a brief review of the related literature.
Autopsy ; Biliary Tract ; Cholangiography ; Diagnosis ; Diverticulum ; Embryonic Development ; Female ; Gallbladder Diseases ; Gallbladder* ; Liver ; Pregnancy ; Urinary Bladder

PURPOSE: A Laparoscopic cholecystectomy has been the treatment of choice for acute and chronic disease of the gallbladder. We have performed about 1, 500 cases of laparoscopic cholecystectomy since 1991. The purpose of this study is to analyse 1, 000 cases of laparoscopic cholecystectomy performed by a single surgeon and observe the effectiveness of this form of treatment of for gallbladder disease. METHODS: From March 1993 to December 2001, 1, 000 patients underwent a laparoscopic cholecystectomy at our department by a single surgeon. They were divided into 2 groups; group 1 being those of the first half of the period and group 2 being those of second half. We reviewed the patient's charts, age, sex, associated medical diseases, final diagnosis, operation time, occurrence of conversion from laparoscopic to open cholecystectomy, surgical complication and hospital stay. RESULTS: The mean age was 51.2+/-2.37 years and the male-to-female ratio was 1: 1.3. There was no difference of age or sex between two groups. Nineteen percent from group 1 and 16.6% from group 2 had a history of previous abdominal surgery. 22.2% from group 1 and 28.6% from group 2 had a associated disease. Chronic cholecystitis was the most common final diagnosis in both groups. But while the incidence of acute cholecystitis of group 1 was 7%, that of group 2 was 20.6%, which significantly increased (P<0.05). The mean operation time was 69.4 and 45.2 minutes, the conversion rate was 3.8% and 1.2% (P<0.05). The surgical complication rate was 4.4% and 2.4%, and the length of hospital stay was 4.7 and 3.9 days in groups 1 and 2, respectively Conclusion: Laparoscopic cholecystectomy is a safe and effective treatment for gallbladder diseases. As surgical experience incerased with a rising number of cases, the conversion rate, complication rate and hospital stay decreased. However, the rate of acute cholecystitis increased. For this result, we think that an excellent skill and significant experience of surgeon is essential for this results.
Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cholecystitis, Acute ; Chronic Disease ; Diagnosis ; Gallbladder ; Gallbladder Diseases ; Humans ; Incidence ; Length of Stay

PURPOSE: The aim of this study was to evaluate whether the comet tail artifact on ultrasonography can be used to reliably diagnose benign gallbladder diseases. METHODS: This retrospective study reviewed the clinical findings, imaging findings, preoperative ultrasonographic diagnoses, and pathological diagnoses of 150 patients with comet tail artifacts who underwent laparoscopic cholecystectomy with pathologic confirmation. The extent of the involved lesion was classified as localized or diffuse, depending on the degree of involvement and the anatomical section of the gallbladder that was involved. This study evaluated the differences in clinical and imaging findings among pathologic diagnoses. RESULTS: All gallbladder lesions exhibiting the comet tail artifact on ultrasound examination were confirmed as benign gallbladder diseases after cholecystectomy, including 71 cases of adenomyomatosis (47.3%), 74 cases of chronic cholecystitis (49.3%), two cases of xanthogranulomatous cholecystitis (1.3%), and three cases of cholesterolosis (2.0%); there were two cases of coexistent chronic cholecystitis and low-grade dysplasia. There were no statistically significant differences in any of the clinical and ultrasonographic findings, with the exception of gallstones (P=0.007), among the four diseases. There were no significant differences in the average length, thickness, or number of comet tail artifacts among the four diagnoses. No malignancies were detected in any of the 150 thickened gallbladder lesions. CONCLUSION: The ultrasonographic finding of the comet tail artifact in patients with thickened gallbladder lesions is associated with the presence of benign gallbladder diseases, and can be considered a reliable sign of benign gallbladder disease.
Artifacts ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Diagnosis ; Gallbladder Diseases ; Gallbladder ; Gallstones ; Humans ; Retrospective Studies ; Tail ; Ultrasonography