SLE is an autoimmune disease with multiorgan involvement and a wide range of clinical manifestations, and inflammation of gallbladder also can be represented. There were a few cases of acute acalculous cholecystitis (AAC) in previous reports. Most of them tended to already know about underlying SLE when detected AAC at that time. It may be difficult to detect AAC caused by SLE not due to biliary stone if physician is not conscious of undiagnosed lupus. We introduce a 70-year old female patient, who is diagnosed with AAC. Her symptoms were satisfied the ACR classification criteria for SLE, and was diagnosed with SLE, simultaneously. After a high dose steroid pulse therapy, followed by cyclophosphamide, her symptoms have improved rapidly. In order to better diagnose and treat the disease, we need to be aware of AAC as a potential manifestation of SLE.
Acalculous Cholecystitis* ; Autoimmune Diseases ; Cholecystitis ; Classification ; Cyclophosphamide ; Female ; Gallbladder ; Humans ; Inflammation ; Lupus Erythematosus, Systemic*

BACKGROUND/AIMS: Gallstone pathogenesis is linked to mucin hypersecretion and bacterial infection. Several mucin genes have been identified in gallbladder epithelial cells (GBECs). We investigated MUC expression in cholesterol-associated gallbladder disease and evaluated the relationship between mucin and bacterial infection. METHODS: The present study involved 20 patients with cholesterol stones with cholecystitis, five with cholesterol stones with cholesterolosis, six with cholesterol polyps, two with gallbladder cancer, and six controls. Canine GBECs treated with lipopolysaccharide were also studied. MUC3, MUC5AC, MUC5B, and MUC6 antibodies were used for dot/slot immunoblotting and immunohistochemical studies of the gallbladder epithelial tissues, canine GBECs, and bile. Reverse-transcription polymerase chain reaction was performed to evaluate MUC3 and MUC5B expression. RESULTS: MUC3, MUC5AC, MUC5B, and MUC6 were expressed in the normal gallbladder epithelium, and of those, MUC3 and MUC5B exhibited the highest expression levels. Greatly increased levels of MUC3 and MUC5B expression were observed in the cholesterol stone group, and slightly increased levels were observed in the cholesterol polyp group; MUC3 and MUC5B mRNA was also upregulated in those groups. Canine GBECs treated with lipopolysaccharide also showed upregulation of MUC3 and MUC5B. CONCLUSIONS: The mucin genes with the highest expression levels in gallbladder tissue in cholesterol-associated diseases were MUC3 and MUC5B. Cholesterol stones and gallbladder infections were associated with increased MUC3 and MUC5B expression.
Antibodies ; Bacterial Infections ; Bile ; Cholecystitis ; Cholesterol ; Epithelial Cells ; Epithelium ; Gallbladder Diseases* ; Gallbladder Neoplasms ; Gallbladder* ; Gallstones ; Humans ; Immunoblotting ; Mucins ; Polymerase Chain Reaction ; Polyps ; RNA, Messenger ; Up-Regulation

Hemobilia is a rare upper gastrointestinal (GI) bleeding phenomenon usually caused by trauma but may occur due to various liver and pancreatobiliary diseases. Causes related to gallbladder disease include vascular disorders, malignancy, polyps, heterotopic GI mucosa, acalculous inflammation, and most commonly gallstones. Most cases are treated with a cholecystectomy. If hemobilia is detected, efforts must be made to exclude malignancy because hemobilia develops from both benign and malignant disease. Particularly in gallbladder disease with hemobilia, the possibility of gallbladder carcinoma should be considered. We report two cases of hemoblia by endoscopic retrograde cholangiopancreatography and duodenoscopy, with a review of the literature. The first case was xanthoglanulomatous cholesystitis and the second case was gallbladder cancer disclosed by cholecystectomy.
Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cholecystitis ; Duodenoscopy ; Gallbladder ; Gallbladder Diseases ; Gallbladder Neoplasms ; Gallstones ; Granuloma ; Hemobilia ; Hemorrhage ; Inflammation ; Liver ; Mucous Membrane ; Polyps ; Xanthomatosis

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

Several gastrointestinal complications have been reported in association with systemic lupus erythematosus (SLE),including mesenteric vasculitis,bowel perforation,gastric or duodenal ulcer,necrotizing enterocolitis,spontaneous peritonitis,pancreatitis,spontaneous rupture of the liver or spleen and hepatomegaly.Acute acalculous cholecystitis is a rare disease that occurs in only 5~10%of patients with acute cholecystitis,typically in seriously ill patients. Reports of gallbladder diseases in patients with SLE are very scarce.Only seven cases of SLE complicated with acalculous cholecystitis have been reported so far, but not in Korea.Six cases were treated surgically by cholecystectomy or cholecystostomy,and one case was treated without surgical intervention.We added a case in which acute acalculous cholecystitis accompanying SLE was treated successfully by corticosteroid without surgical intervention.
Acalculous Cholecystitis* ; Cholecystectomy ; Gallbladder Diseases ; Humans ; Liver ; Lupus Erythematosus, Systemic* ; Rare Diseases ; Rupture ; Spleen

PURPOSE: A laparoscopic cholecystectomy is the treatment of choice for gallbladder disease. The aim of this study is to analyse 2,239 cases of laparoscopic cholecystectomy (LC) and observe the changes of 15th-year gallbladder disease. METHODS: We performed a retrospective analysis of 2,239 patients that underwent a LC by a single surgeon, from March 1993 to December 2007. We divided it into 3 groups; group 1 was from March 1993 to December 1996 and group 2 was from January 1998 to December to 2001, group 3 was from January 2003 to December 2007. RESULTS: The mean age, hospital stay, mean operation time and conversion rate was decreased. Gallbladder cancer of group 1 was 0.6%, group 2 was 0.5%, and group 3 was 1.6% (P<0.05). Gallbladder polyps of group 1 was 3.3%, group 2 was 5.1%, and group 3 was 11.8%. There was statistically significance (P<0.05). Gallstone was significantly decreased (group 1 was 98.1%, group 2 was 97.6%, group 3 was 92.8%) in proportion, pigment stone was significantly decreased (group 1 was 31.5%, group 2 was 27.5%, group 3 was 21.7%) and Cholesterol & Mixed stone was significantly increased (group 1 was 68.2%, group 2 was 72.5%, group 3 was 78.3%)(P<0.05). CONCLUSION: As surgical experience increased with a rising number of cases, the conversion rate, complications, hospital stay and mean operation time was decreased. Pigment gallstone was decreased and cholesterol gallstone was increased owing to western diet, old age and fatness.
Cholecystectomy, Laparoscopic ; Cholesterol ; Diet ; Gallbladder ; Gallbladder Diseases ; Gallbladder Neoplasms ; Gallstones ; Humans ; Length of Stay ; Polyps ; Retrospective Studies

Benign gallbladder diseases are common in surgery department,and the incidence rate is increasing in recent years.Currently,nonstandard treatment existed in the surgical management of benign gallbladder diseases in China.Based on relevant domestic and foreign literature,guidelines,and expert consensus,this consensus expounds on the diagnosis and surgical treatment of common benign gallbladder diseases such as gallstone,cholecystitis,gallbladder polypoid,gallbladder adenomyosis,gallbladder variation and deformity,complications after cholecystectomy.Further,recommendations related to diagnosis and treatment were presented to improve the standardization of surgical diagnosis and treatment of benign gallbladder diseases in China,so as to eliminate the clinical harm of gallbladder diseases and reduce the incidence rate of gallbladder cancer and prevent the occurrence.
Cholecystectomy ; Consensus ; Gallbladder ; Gallbladder Diseases/surgery* ; Gallbladder Neoplasms/surgery* ; Gallstones/surgery* ; Humans

PURPOSE: To assess the role of percutaneous cholecystostomy as a therapeutic maneuver in patients critically ill with acute cholecystitis in community hospitals. MATERIALS AND METHODS: Eighteen patients, 11 with suspected acute calculous cholecystits and seven with acute acalculous cholecystitis underwent emergency percutaneous cholecystostomy. All demonstrated a variety of high risk factors for cholecystectomy: liver cirrhosis (n=2), diabetes mellitus (n=3), cardiac disease (n=3), underlying malignancy (n=2), pulmonary dysfunction (n=1), septic cholangitis (n=5), and old age (n=2). All percutaneous cholecystostomies were performed with ultrasound guidance and preferably using the transhepatic route. RESULTS: All procedures but one were successful, and most cholecystostomies were performed within 5-20 minutes. Technical problems were as follows: guide-wire buckling during catheter insertion (n=2) and procedure failure (n=1). The only major problem was a case of localized bile peritonitis due to procedural failure, but a few minor complications were encountered: catheter dislodgment (n=3), and significant abdominal pain during the procedure (2). After successful cholecystostomy, a dramatic improvement in clinical condition was observed in 16 of 17 patients (94%) within 48 hours. Ten of 16 patients who responded to percutaneous cholecystostomy underwent elective cholecystectomy after the improvement of clinical symptoms, and the remaining six patients improved without other gallbladder interventions. CONCLUSION: Percutaneous cholecystostomy is not only an effective procedure for acute cholecystitis, but also has a definite role in the management of these high-risk patients in community hospitals.
Abdominal Pain ; Acalculous Cholecystitis ; Bile ; Catheters ; Cholangitis ; Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute ; Cholecystostomy* ; Critical Illness ; Diabetes Mellitus ; Emergencies ; Gallbladder ; Heart Diseases ; Hospitals, Community* ; Humans ; Liver Cirrhosis ; Peritonitis ; Risk Factors ; Ultrasonography

Churg-Strauss syndrome is an uncommon disorder characterized by asthma, hypereosinophilia, and systemic vasculitis. Gastrointestinal involvement is commonly encountered in Churg-Strauss syndrome; however, acute cholecystitis is rare, and few cases have been documented in the literature. A 22-year-old female with a history of asthma was admitted with a complaint of steady pain in the right upper abdominal quadrant. Laboratory test results showed leukocytosis with hypereosinophilia. Abdominal ultrasonography and computed tomography revealed acute cholecystitis. Her symptoms did not improve with conservative treatment, so she underwent percutaneous transhepatic gallbladder drainage. Subsequently, peripheral neuropathy, erythematous papules on the skin, and dyspnea developed. A chest computed tomography scan showed bilateral pulmonary infiltrates. A pathological examination of the skin lesion indicated necrotizing vasculitis with eosinophilic infiltrates. She was diagnosed with Churg-Strauss syndrome. She was treated with corticosteroids, and her condition improved dramatically. After the drainage catheter was removed, complications including a bile leak occurred. Consequently, a cholecystectomy was performed.
Acalculous Cholecystitis ; Adrenal Cortex Hormones ; Asthma ; Bile ; Catheters ; Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute ; Churg-Strauss Syndrome ; Drainage ; Dyspnea ; Eosinophils ; Female ; Gallbladder ; Humans ; Leukocytosis ; Peripheral Nervous System Diseases ; Skin ; Systemic Vasculitis ; Thorax ; Vasculitis ; Young Adult

Primary gallbladder carcinoma is relatively uncommon, but not a very rare disease. It accounts for 3- 4% of all gastrointestinal tract tumors, and is the most common malignant disease of the biliary tract. It occurs more frequently in women than in men at a ratio of 3:1. The etiology of gallbladder carcinoma is unknown, but the association of gallstones with it is well known. The diagnosis often is not made before laparotomy because its symptoms and signs are very nonspecific and are similar to those of cholecystitis. Commonly, it is encountered in the later stages and has very unfavorable courses. Recently, the operative treatments of gallbladder carcinoma have advanced significantly, and many studies revealed that more aggressive surgery gives rise to better prognosis in comparison with previous surgical treatment modalities. We reviewed 60 cases of this disease experienced in our hospital from October, 1988 to February, 1998. We evaluated whether the aggressive surgical treatment and the adjuvant therpy of gallbladder cancer had influence on prognosis. And additionally, we examined the clinical situations of primary gallbladder carcinoma. Only 33 patients of 60 were followed up until a recent date, and so all survival data were calculated within 33 cases. The results are as follows : 1) The incidence of gallbladder carcinoma in females outnumbered in males at a ratio of 1.2:1, and sixty per cent of all patients were 7th and 8th decades of age. 2) Almost all patients had varying degrees of upper abdominal pain, and the duration of symptoms was less than 4 weeks in half of the patients. 3) Forty-five per cent of all patients had gallstones. 4) Preoperative diagnoses were made in 28 cases(46.7%). 5) At the time of diagnosis, many patients(about 70%) were on the TNM stage III and IV. 6) The curative resectability rate of the cancer was merely 53.3%(32/60), and in the remainder of patients(n=28), palliative surgery and only laparotomy were carried out. The operative methods performed on purpose of a curative resection of the cancer were simple cholecystectomy in 14 patients(23.3%), cholecystectomy plus liver wedge resection plus LN dissection(radical cholecystectomy) in 15 patients(25%), radical cholecystectomy plus Roux-en-Y hepaticojejunostomy in 1(1.7%), and radical cholecystectomy plus right hepatic lobectomy in 2(3.3%). 7) The cumulative 5-year-survival rates of gallbladder carcinoma were 80% in stage I, 75% in stage II, 33% in stage III, and 0% in stage IV(p=0.002). In advanced cases(that is, in stage III and IV), the survival data was analized according to the operation methods. The mean survival times were 25.9 months in curative operation group and 3.3 months in palliative operation or explo-laparotomy group(p=0.003). 8) In a small number of patients of stage III and IV, chemotherapy and radiation therapy were carried out. But we could not find the statistical significances on the differences of survival rates.
Abdominal Pain ; Biliary Tract ; Cholecystectomy ; Cholecystitis ; Diagnosis ; Drug Therapy ; Female ; Gallbladder Neoplasms* ; Gallbladder* ; Gallstones ; Gastrointestinal Tract ; Humans ; Incidence ; Laparotomy ; Liver ; Male ; Palliative Care ; Prognosis ; Rare Diseases ; Survival Rate