PURPOSE: Cholecystectomy in patients with an intact gallbladder after endoscopic removal of stones from the common bile duct (CBD) remains controversial. We conducted a case-control study to determine the risk of recurrent CBD stones and the benefit of cholecystectomy for prevention of recurrence after endoscopic removal of stones from the CBD in Korean patients. MATERIALS AND METHODS: A total of 317 patients who underwent endoscopic CBD stone extraction between 2006 and 2012 were included. Possible risk factors for the recurrence of CBD stones including previous cholecystectomy history, bile duct diameter, stone size, number of stones, stone composition, and the presence of a periampullary diverticulum were analyzed. RESULTS: The mean duration of follow-up after CBD stone extraction was 25.4+/-22.0 months. A CBD diameter of 15 mm or larger [odds ratio (OR), 1.930; 95% confidence interval (CI), 1.098 to 3.391; p=0.022] and the presence of a periampullary diverticulum (OR, 1.859; 95% CI, 1.014 to 3.408; p=0.045) were independent predictive factors for CBD stone recurrence. Seventeen patients (26.6%) in the recurrence group underwent elective cholecystectomy soon after endoscopic extraction of CBD stones, compared to 88 (34.8%) in the non-recurrence group; the difference was not statistically significant (p=0.212). CONCLUSION: A CBD diameter of 15 mm or larger and the presence of a periampullary diverticulum were found to be potential predictive factors for recurrence after endoscopic extraction of CBD stones. Elective cholecystectomy after clearance of CBD stones did not reduce the incidence of recurrent CBD stones in Korean patients.
Adult ; Aged ; Bile Duct Diseases/*diagnosis/epidemiology/surgery ; Case-Control Studies ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy/*methods ; Common Bile Duct/*pathology/radiography ; Elective Surgical Procedures ; Female ; Gallstones/epidemiology/*surgery ; Humans ; Incidence ; Male ; Middle Aged ; Recurrence ; Republic of Korea/epidemiology ; Risk Factors ; *Sphincterotomy, Endoscopic

A 43-year-old man, who received total gastrectomy five years ago for advanced gastric cancer, underwent a screening colonoscopy and abdominal CT scan. Abdominal CT scan revealed no abnormal findings. Colonoscopy revealed polyps at the rectum, which were removed by polypectomy. The patient did not complain of abdominal pain or discomfort throughout the procedure. But, he developed right upper quadrant abdominal pain on the next day after colonoscopy. Abdominal CT scan revealed the distended gallbladder with mild wall thickening and suspicious sandy stones or sludge in the gallbladder. The patient underwent an open cholecystectomy. Pathology was compatible with acute cholecystitis. We should be aware of and consider cholecystitis in the differential diagnosis for patients with abdominal pain after colonoscopy.
Adult ; Cholangiopancreatography, Magnetic Resonance ; Cholecystectomy ; Cholecystitis, Acute/*diagnosis/etiology/pathology ; Colonoscopy/*adverse effects ; Diagnosis, Differential ; Gallbladder/pathology ; Gallstones/diagnosis ; Humans ; Male ; Polyps/pathology ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Intraoperative cholangiogram (IOC) during laparoscopic cholecystectomy (LC) has been used to evaluate bile duct stone. But, the routine use of IOC remains controversial. With routine IOC during LC, we reviewed the variation of hepatic duct confluence and try to suggest the diagnostic criteria of asymptomatic common bile duct (CBD) stone. METHODS: We reviewed the medical record of 970 consecutive patients who underwent LC with IOC from January 1999 to December 2009, retrospectively. RESULTS: Nine hundered seventy patients were enrolled. IOC were successful in 957 (98.7%) and unsuccessful in 13 (1.3%). Eighty two of 957 patients (8.2%) were excluded because of no or poor radiologic image. According to Couinaud's classification, 492 patients (56.2%) had type A hepatic duct confluence, 227 patients (26.1%) type B, 15 patients (17%) type C1, 43 patients (4.9%) type C2, 72 patients (8.2%) type D1, 21 patients (2.4%) type D2, 1 patient (0.1%) type E1, 1 patient (0.1%) type E2, 2 patients (0.2%) type F, and 1 patient (0.1%) no classified type. The CBD stone was found in 116 of 970 (12.2%) patients. In 281 patients, preoperative serologic and radiologic tests did not show abnormality. When preoperative findings were not remarkable, there was no difference of clinical features between patients with or without CBD stones. CONCLUSIONS: Although IOC during LC has some demerits, it is a safe and accurate method for the detection of CBD stone and the anatomic variation of intrahepatic duct.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Body Mass Index ; Cholangiography ; *Cholecystectomy, Laparoscopic ; Female ; Gallstones/*diagnosis/pathology ; Hepatic Duct, Common/anatomy & histology/*radiography ; Humans ; Intraoperative Period ; Male ; Middle Aged ; Retrospective Studies

Female ; Gallstones ; pathology ; surgery ; Humans ; Hyperparathyroidism, Primary ; diagnosis ; surgery ; Pancreatitis ; pathology ; surgery ; Young Adult

OBJECTIVETo find out potential molecular targets for gallbladder carcinoma diagnosis and treatment by analyzing and comparing the proteins expressed in human gallbladder carcinoma tissue and benign gallbladder tissue.

METHODSProteomic analysis of 6 human gallbladder carcinoma tissues and 6 benign gallbladder tissues was carried out. Total proteins of the carcinoma tissue and benign gallbladder tissue were separated by two-dimensional gel electrophoresis (2-DE). The differentially expressed proteins were analyzed and identified by matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS). Immunohistochemistry was used to examine the expression of PEBP1 protein in an independent series of samples.

RESULTSProtein extracts of individual samples in each type of tissues were separated on two-dimensional gels. There were forty six differentially expressed proteins in the gallbladder carcinom tissues. Seventeen proteins were successfully identified by MS, in which nine proteins were overexpressed in tumors while the other eight proteins were underexpressed. The increased level of PEBP1 protein in gallbladder carcinoma was further confirmed by immunohistochemical analysis.

CONCLUSIONSeventeen differentially expressed proteins were successfully characterized by comparative proteomic analysis. Those results may provide scientific foundation for screening the molecular biomarkers which can be used in diagnosis and treatment of gallbladder carcinoma, as well as to improve its prognosis and provide a new clue for carcinogenesis research of gallbladder carcinoma.

Adenocarcinoma ; diagnosis ; metabolism ; pathology ; Adult ; Aged ; Biomarkers, Tumor ; analysis ; Electrophoresis, Gel, Two-Dimensional ; Gallbladder Neoplasms ; diagnosis ; metabolism ; pathology ; Gallstones ; diagnosis ; metabolism ; pathology ; Gene Expression Profiling ; Humans ; Immunohistochemistry ; Middle Aged ; Phosphatidylethanolamine Binding Protein ; metabolism ; Proteomics ; methods ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization

Hemorrhagic acalculous cholecystitis is an extremely rare but potentially fatal disease if detection is delayed. Its risk factors include critical illness, diabetes, malignant disease, uremia, and bleeding diathesis. This is the first case report in which hemorrhagic acalculous cholecystitis not accompanied by any risk factor. We herein present a case of hemorrhagic acalculous cholecystitis in a previously healthy patient who suffered from acute abdomen.
Acalculous Cholecystitis/complications/*diagnosis/pathology ; Adult ; Endoscopy, Gastrointestinal ; Gallbladder/pathology ; Gallstones/diagnosis ; Hemobilia/*complications ; Humans ; Magnetic Resonance Imaging ; Male ; Tomography, X-Ray Computed

Bezoars ; complications ; Fruit ; adverse effects ; Gallstones ; diagnosis ; pathology ; Humans ; Ileus ; diagnosis ; etiology ; Male ; Middle Aged ; Seeds ; adverse effects ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is the most accurate modality in diagnosis of choledocholithiasis. However, it carries some complications. Endoscopic ultrasonography (EUS) is less invasive than ERCP and used for the diagnosis of choledocholithiasis. Recent studies showed that a usefulness of EUS for the diagnosis of small choledocholithiasis without common bile duct (CBD) dilatation. For such a reason, ERCP is being replaced by EUS in the diagnosis of bile duct stones. The aim of this study was to investigate the accuracy of EUS for the diagnosis of choledocholithiasis without CBD dilatation. METHODS: A total of 66 patients with suspected choledocholithiasis without CBD dilatation were enrolled. EUS were performed in all cases within 48 hours after computed tomography (CT) or ultrasonography (US). Final diagnosis was obtained by ERCP or clinical course (minimum 6 months follow-up). We analyzed the accuracy of US, CT, and EUS, respectively. RESULTS: CT and US were performed in 51 and 15 cases, respectively. CBD stones were detected in 23 (35%) patients by ERCP. EUS showed 100% sensitivity, 95% specificity, 92% positive predictive value, and 100% negative predictive value for identifying CBD stones. CT or US showed 26%, 93%, 67%, and 70%, respectively. There were no EUS-related complications. CONCLUSIONS: EUS was more effective than CT or US and as accurate as ERCP for the diagnosis of small choledocholithiasis without CBD dilatation. Thus, EUS may help to avoid unnecessary diagnostic ERCP and its complication.
Adult ; Aged ; Aged, 80 and over ; Choledocholithiasis/pathology/*ultrasonography ; Common Bile Duct Diseases/diagnosis ; Diagnosis, Differential ; Dilatation, Pathologic/diagnosis ; *Endosonography ; Female ; Gallstones/ultrasonography ; Humans ; Male ; Middle Aged ; Sensitivity and Specificity ; Tomography, X-Ray Computed

OBJECTIVETo study the value of digital medical technology in diagnosis and treatment of the hepatolithiasis.

METHODS64-slice spiral computer tomography (CT) scan data of 14 cases (11 female, 3 male; median age, 48 years) with hepatolithiasis admitted from February to September 2008 were collected. The data were imported into medical image proceeding system (MIPS) for sequence segmenting and three-dimensional (3D) reconstruction. The reconstructed models were imported into FreeForm Modeling System for performing simulation surgery with simulation surgical instruments. According to the results of 3D reconstruction and simulation surgery, reasonable operation strategies were chosen. Finally, the value of clinical application of simulation surgery was evaluated according to the findings of clinical operation on hepatolithiasis patients and postoperative T-tube angiography.

RESULTSThe 3D reconstructed models of 14 cases with hepatolithiasis revealed 7 cases of left liver hepatolithiasis, 2 cases of right liver hepatolithiasis, 5 cases of bilateral hepatolithiasis, including 6 cases of hepatolithiasis with common bile duct calculi, 6 cases of biliary system models with absolute stricture, 8 cases with relative stricture. The results were of agreement with clinical diagnosis. A variety of operation plans were simulated before operation. Simulation equipment used in process of simulation surgery was a powerful sense of feedback.

CONCLUSIONSDigital medical technology is helpful to understand the calculi distribution, bile ducts stricture and deformity. Through preoperative training, simulation surgery are able to guide for choosing operative strategies. It reduces the operation risks.

Adult ; Aged ; Computer Simulation ; Female ; Gallstones ; diagnosis ; surgery ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Liver ; pathology ; Male ; Middle Aged ; Models, Anatomic ; Tomography, Spiral Computed

No abstract available.
Adult ; Bile Ducts, Intrahepatic/pathology ; Caroli Disease/complications/*diagnosis/pathology ; Gallstones/complications/*diagnosis/radiography ; Humans ; Male ; Tomography, X-Ray Computed