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

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

OBJECTIVETo discuss the principles of diagnosis and treatment of the polypoid lesion of gallbladder.

METHODSClinical and pathological features of 342 cases were analysed.

RESULTSTotally 328 patients with benign polypoid lesions (including 234 cholesterol polyps, and 74 adenomas), and 14 patients with malignant polypoid lesions (including 10 adenocarcinomas and 4 adenomas with malignant changes) were included. Two hundred and forty-seven cases (72.2%) had symptoms. Seventy-eight point six percent of patients with malignant polyps were over 50 years of age, and while 29.9 percent of patients with non-malignant polyps were over 50 years. The lesions were more than 1 cm in 91.7% of the malignant polyps and in only 13.2% of the benign polyps. One hundred percent of malignant polyps, and 46 percent of benign polyps were single polyp.

CONCLUSIONSCholesterol polyps, adenomas, and adenocarcinomas are the most common lesions in polypoid lesion of the gallbladder. Cholecystectomy should be done in patients with symptoms. The risk factors for malignancy are the age of the patient (> 50), the size (> 1 cm), and number (single) of the polypoid lesions. In asymptomatic patients, cholecystectomy can be justified after integrated analysis.

Adenocarcinoma ; diagnostic imaging ; surgery ; Adenomatous Polyps ; diagnostic imaging ; pathology ; surgery ; Adult ; Aged ; Aged, 80 and over ; Cholecystectomy, Laparoscopic ; Cholelithiasis ; diagnostic imaging ; surgery ; Diagnosis, Differential ; Female ; Gallbladder Diseases ; diagnostic imaging ; pathology ; surgery ; Gallbladder Neoplasms ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Polyps ; diagnostic imaging ; pathology ; surgery ; Retrospective Studies ; 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

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: It is well known that the incidence of cholelithiasis and cholecystitis increases after a gastrectomy and vagotomy for peptic ulcer disease, but operations for ulcers have decreased due to improved medical therapy. However, there are not so many studies about cholelithiasis and cholecystitis after a gastric resection due to gastric cancer. Therefore, we investigated its incidence, the factors affecting it, and its natural course. METHODS: Six hundred eighty-four gastric patients who had received a gastric resection at the Korea University Guro Hospital from January 1992 to October 1999 and who had been followed regularly with abdominal ultrasonography or computed tomography were enrolled in this study. The incidence of gallstones and sludge was investigated according to age group (< OR =60 vs >60), sex, extent of gastric resection (subtotal vs total), anastomotic methods (duodenal bypass vs duodenal passage of food), and degree of lymph node dissection (< OR =D2 vs > or =D2+alpha). The clinical course of cholelithiasis was also followed up. RESULTS: Gallstones were discovered in 38 patients (5.6%) with a mean duration of 26.4+/-20.7 months, and sludge was found in 17 patients (2.5%) with a mean duration of 25.1+/-20.5 months. There were no significant differences of incidence of gallstones and sludge according to sex, age group, and other surgical options (p>0.05). Twenty- eight cases of gallstones (73.7%) were detected within 36 months, and 11 cases of sludge (64.7%) within 24 months. Among the 38 gallstones patient, only 7 patients (18.4%) developed acute cholecystitis; they received cholecystectomy during the follow-up period, and all removed stones were pigment stones. CONCLUSION: The incidences of cholelithiasis and chole-cystitis do not increased very much after a gastric resection with lymph-node dissection due to gastric cancer, and there are no specific factors affecting those incidences. A prophylactic cholecystectomy during the gastric cancer operation should be performed with caution.
Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute ; Cholelithiasis* ; Follow-Up Studies ; Gallstones ; Gastrectomy ; Humans ; Incidence ; Korea ; Lymph Node Excision ; Peptic Ulcer ; Sewage ; Stomach Neoplasms* ; Ulcer ; Ultrasonography ; Vagotomy