Study 759 patients who had gallstone surgery from May 1993 to May 2003. Result: gallstone is common. There is an increase of patients day by day. Female: 25,31% is more than male: 47,69%, the age from 21 to 83. Clinical signals are almost charcot symtom in 80%, relevant with the case of infected gall, OMC calculaus combining with calculaus in lung with high percentage (50,59%). Diagnostic ultrasonic results in high accuracy 89,33% which is convenient, simple, harmless, and quick. Treatment applied is surgery withdrawing kehr calculaus
Gallstones ; Bile ; diagnosis ; Therapeutics ; surgery

Twenty cases of polypoid lesions of the gallbladder were reviewed. Seven were benign lesions. Among them, there were 4 (20%) adenomas and 3 (15%) adenomatous hyperplasias. All of the benign lesions were less than 1 cm in diameter. Thirteen cases involved a carcinoma of the gallbladder, of which 92% were more than 1 cm in diameter, 76.9% were over 60 years of age, and 38.5% were associated with gallstones. The accuracy of the preoperative ultrasonographic diagnosis of the polypoid lesions of the gallbladder was 80%. The spread and the size of the tumor showed a close correlation. Therefore, the size of the tumor is a vital indicator for the treatment of polypoid lesions of the gallbladder; lesions between 0.6~1 cm in diameter should be followed up by ultrasonography. An operation may be considered if stones are present. Lesions bigger than 1 cm should be resected since malignancy can not be excluded.
Adenoma ; Diagnosis ; Gallbladder Neoplasms ; Gallbladder* ; Gallstones ; Hyperplasia ; Polyps ; Ultrasonography

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

BACKGROUND/AIMS: The early diagnosis of possible cancer in thickened gallbladder wall is very important. This study was aimed to confirm the usefulness of endoscopic ultrasonography in differential diagnosis of gallbladder cancer in thickened gallbladder wall, and to find out the findings of endoscopic ultrasonography which favor malignancy. METHODS: We reviewed 67 cases of patients who underwent cholecystectomies and who also showed thickened gallbladder wall in their preoperative endoscopic ultrasonography. According to the post-surgical pathologic diagnosis, the cases were classified into malignant and benign diseases, and they were statistically compared with several findings of endoscopic ultrasonography of thickened gallbladder wall. RESULTS: Pathologic diagnosis included 10 cancers and 57 benign diseases. The sensitivity (90%) and specificity (98%) of endoscopic ultrasonography for diagnosis of gallbladder cancer were superior to those of other techniques. Wall thickness, associations of gallstones, loss or preservation of layered structure and irregularity of inner surface of thickened wall were significant variables in the differential diagnosis between malignant and benign causes of thickened gallbladder wall (p<0.05). CONCLUSIONS: Endoscopic ultrasonography is useful to diagnose gallbladder cancer within thickened wall. Loss of layered structure and irregular inner surface of thickened wall are independent predictive factor of gallbladder cancer.
Cholecystectomy ; Diagnosis ; Diagnosis, Differential ; Early Diagnosis ; Endosonography ; Gallbladder Neoplasms ; Gallbladder* ; Gallstones ; Humans ; Sensitivity and Specificity

Aged, 80 and over ; Gallstones ; complications ; diagnosis ; Gastric Outlet Obstruction ; diagnosis ; etiology ; Humans ; Male

BACKGROUND/AIMS: Gallstone pancreatitis has showed higher mortality and morbidity rate as compared to other causes of pancreatitis, and the proper timing of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) is still controversial. But recent several trials reveals early ERCP/EST is safe procedure and can reduce mortality and complication rate in gallstone pancreatitis. METHODS: To assess the safety and effectiveness of early ERCP/EST, we perfomed ERCP and EST, if necessary, in 40 cases of acute gallstone pancreatitis. RESULTS: 1) Early ERCP group (in 72 hours) were 27 cases, delayed group were 13 cases, and 11 early EST group, 16 delayed EST group. No statistically significant difference was found between two groups in blood chemistry and the severity of pancreatitis according to Ranson's criteria, respectively. No remarkable complication due to ERCP or EST was noted, and the hospital days were shorter in early ERCP/EST group with statistical significance, 2) Duodenoscopic findings show 14 normal papillae, 20 papillary edema, hemorrhagic and lacerated papillae in 6 cases. CONCLUSION: In cases of gallstone pancreatitis, early ERCP and EST is considered as a safe and effective treatment modality.
Chemistry ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis* ; Edema ; Gallstones* ; Mortality ; Pancreatitis* ; Sphincterotomy, Endoscopic

Perforation of gallbladder is a serious complication of acute cholecystitis with alarmingly high mortality rate. These high mortality and morbidity rates were caused by delay in prompt diagnosis and adequate therapy. Especially, mortality and morbidity rates rise markedly in the elderly patient with severe systemic illness. In the patients of gallbladder perforation who are poor candidate for general anesthesia and major operation, percutaneous cholecystic drainage procedure is good alternatives. We experienced a case of gallbladder perforation which was treated successfully by non-operative percutaneous transhepatic cholecystic drainage(PTCCD) in 65-year-old female. She couldn't be a candidate for cholecystectomy or operative chlecystostomy because of severe adhesion of gallbladder to adjacent organ and tissue due to previous gallbladder empyema. We decided to take non-operative percutaneous transhepatic cholecystic drainage and percutaneous peritoneal drainage of abdominal abscess. Thereafter, we examined gallbladder by percutaneous transhepatic cholecystoscopylPTCCS)and rule out gallstone and gallbladder malignancy. So, we presented the case with the brief review of the literatures.
Abdominal Abscess ; Aged ; Anesthesia, General ; Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute ; Diagnosis ; Drainage* ; Female ; Gallbladder* ; Gallstones ; Humans ; Mortality

Biliary enteric fistulas which are caused by gallstone, peptic ulcer and carcinoma are an uncommon disease. Their incidence appears to increase recently with the advent of endoscopy. The usual types of the fistulas are choledochoduodenal, cholecystoduodenal and cholecystocolonic. But, cholecystogastric fistulas are very rare. Their symptoms are usually nonspecific and pneumobilia has been considered as a clue, but the diagnosis is difficult in most cases. At present, endoscopy is very helpful to the diagnosis. The treatment of asymptomatic fistulas is still in dispute. Endoscopic management is being used at times in recent days. We recently experienced a case of cholecystogastric fistula accidentally. During the evaluation for the cause of anemia, we suspected a fistula on endoscopy and confirmed it on endoscopic fistulography and managed it by endoscopic papillotomy and stone extraction.
Anemia ; Diagnosis ; Dissent and Disputes ; Endoscopy ; Fistula* ; Gallstones ; Incidence ; Peptic Ulcer ; Sphincterotomy, Endoscopic

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: A laparoscopic cholecystectomy is now the gold standard for the treatment of gallstone disease. While the widespread use of ultrasonography has increased the frequency of the diagnosis of polypoid lesions of the gallbladder (PLG), no optimal strategies for evaluating and treating these lesions have been established. The aims of this study were to identify the risk factors for malignancy, and evaluate the usefulness of laparoscopic cholecystectomy for PLG. METHODS: The clinical and histopathological data from ninety PLG patients, who received a laparoscopic cholecystectomy, between January 1998 and December 2005, were retrospectively analyzed. Data were evaluated using a multiple logistical regression analysis. RESULTS: There were 82 benign PLG, including 38 cholesterol polyps, 22 adenomas, 18 hyperplastic polyps and 4 adenomyomas, and 8 malignant PLG. The average age of the patients with malignant PLG was significantly older than that of those with benign PLG (P=0.001). The average malignant PLG diameter was significantly larger than that of the benign PLG (P=0.000). The malignant PLG were mostly a single lesion; whereas, half of the benign PLG were multiple lesions. In the multiple logistical regression analysis, polyp sizes greater than 1.5 cm and an age over 50 years were the two most important factors for predicting malignancy of PLG. Seven of eight patients with malignant PLG are still alive at a mean of 43.8 months after surgery, and without any recurrence. CONCLUSION: The risk factors for malignancy were found to be the polyp size and patient age. A laparoscopic cholecystectomy can be considered an adequate treatment for patients with a stage I gallbladder carcinoma.
Adenoma ; Adenomyoma ; Cholecystectomy, Laparoscopic* ; Cholesterol ; Diagnosis ; Gallbladder* ; Gallstones ; Humans ; Polyps ; Recurrence ; Retrospective Studies ; Risk Factors ; Ultrasonography