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Researchers nowadays have devoted extra attention to the different biomedical applications of indocyanine green (ICG), a US Food and Drug Administration-approved fluorescent compound in the fields such as drug delivery, medical imaging and disease diagnosis. In addition, hepatic function evaluation could be conducted by using ICG before surgical procedures and angiographic assessment of blood. Therefore, ICG will be expected to be excellent imaging and targeting agent in various preclinical and clinical model systems. However, whether ICG possesses the potential for the gall bladder's intraoperative imaging guidance needs to be further explored in vivo animal experiments. Herein, near-infrared fluorophores ICG can display the specific uptake by the gall bladder cells and tissues. The dynamic process of biodistribution and the clearance of ICG in vivo in mice are clearly shown in real-time live-body imaging. Furthermore, ICG was rapidly excreted into the bile and lately biodistributed to the stomach after treatment in mice. Meanwhile, the signal-to-background ratio of the gall bladder demonstrated a tremendously higher level compared to other organs (stomach, heart, liver, lung, pancreas, spleen, intestine and duodenum). In conclusion, fluorescence navigation using ICG fluorescence imaging will provide good visualization and detection of the target lesions (gall bladder) in clinics such as diagnostic medical imaging and intraoperative navigation., (© 2022 Wiley-VCH GmbH.)

Gall bladder is known for many congenital anomalies such as duplication, intrahepatic position, floating position etc. Most of its anomalies can be detected in ultrasound examination and radiography. We report an extremely rare congenital anomaly of gall bladder as observed in a male cadaver during dissection classes. The gall bladder was totally enclosed in the right free margin of the lesser omentum, in front of the usual contents of the right free margin of lesser omentum. The size, shape and blood supply of the gall bladder were normal. Though this anomaly might not cause any functional disturbances, it might result in complications during laparoscopic cholecystectomy., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Increased gallbladder wall thickening (GBWT) is a manifestation of increased capillary permeability caused by severe dengue. This study was carried out to link the severity of GBWT with bleeding risk and the need for transfusion. This retrospective study included all patients diagnosed with dengue infection either via dengue nonstructural protein-1 antigen or IgM antibody. Pearson's correlation, linear regression, and receiver operating characteristic curves were used for predictive analysis of GBWT with events of bleeding and need for transfusion of platelets during the hospital stay. A total of 177 participants met the inclusion criteria; the mean age was 33.17 ± 13.63 years. Mean GBWT was found to be 0.37 ± 0.15 cm, with 46.3% of patients having a thickness greater than 0.30 cm. A total of 16 patients had bleeding events, of which 7.3% had minor bleeding and 1.7% had a major bleeding event. Linear regression analysis showed that increased GBWT was associated with decreased platelet count on admission (P = 0.002) and lowest platelet counts (P = 0.004). GBWT was found to be predictive of bleeding events and transfusion of platelets at higher sensitivity and specificity than was either platelet count on admission and lowest platelet counts.

Background: Subtotal cholecystectomy is utilized in conditions of high risk to critical structures, like the common bile duct. However, the remnant gall bladder may become symptomatic and require a completion cholecystectomy for treatment. This second procedure can itself be a risk to critical structures. To establish the incidence of redo-cholecystectomy and identify risk factors that lead to subtotal cholecystectomy and repeat operation in a review of state-based practices for cholecystectomy., Methods: A search of state coding records relating to cholecystectomy from 1998 to 2016. Patients who were coded for cholecystectomy-related procedures on different dates were identified. Patients who underwent the procedures within 6 months were excluded to avoid acute post-operative complications and gall bladder malignancy., Results: 210 719 cholecystectomies were performed. 1133 required repeat procedure. 616 were excluded, leaving 516 (0.25%) cholecystectomy patients requiring a second cholecystectomy. The subsequent operation was more likely to be an emergency procedure; involve transcystic bile duct exploration, adhesiolysis and require intensive care unit admission post-operatively. A repeat cholecystectomy was more likely to occur after having the primary procedure at a public hospital and when an intra-operative cholangiogram was not performed. Over the study period, the rate of repeat cholecystectomy increased from 0.02% to 0.6%. Incidentally, the rate of intra-operative cholangiogram during a primary cholecystectomy increased from 43% to 73%., Conclusions: Repeat cholecystectomy is an uncommon procedure. A second cholecystectomy is a more complex and likely to require intensive care unit support. Referral to a tertiary hepatobiliary unit is recommended., (© 2020 Royal Australasian College of Surgeons.)

We investigated the histological structure of the graylag goose ( Anser anser ) gall bladder. Sections of the gall bladder were stained with hematoxylin and eosin (H & E), Alcian blue (pH 2.5) for acid mucopolysaccharides, Gomori's method for reticular fibers, Masson's trichrome, periodic acid-Schiff (PAS) and Verhoeff's elastin stain. The goose gall bladder was composed of a tunica mucosa, tunica muscularis and tunica adventitia or tunica serosa. The tunica mucosa formed regularly distributed simple isometric folds plus larger, less numerous, branched folds. The luminal surface was lined by tall columnar epithelial cells that stained for both acid and neutral mucopolysaccharides. The epithelial cells formed a discontinuous striated border of interdigitating microvilli on the luminal surface. Neither a lamina muscularis nor goblet cells were observed in the tunica mucosa. Unusual findings included branched mucosal folds, discontinuous microvilli and absence of an outer longitudinal layer in the tunica muscularis. No marked sex-associated differences were found. The general histochemical and histological structures of the graylag goose gall bladder are similar to those of birds such as chukar partridge and quail, but with some unique elements that may reflect differences in organ function.

Introduction: The gall bladder (GB) is a storage reservoir that allows bile acids to be delivered in a high concentration. The quadrate (QL) and caudate lobes (CL) are functional parts of the liver. The knowledge of the gross and developmental anatomy of GB and CL and QL of liver is important for surgeons who operate in this region. The present study was conducted to examine the developmental sequence and morphometry of the GB, and CL and QL of liver., Materials and Methods: In the present cross sectional study the parameters measured were length of GB from the neck to the lowest point on the fundus, and the length and width of QL and CL measured at the midpoint. The data was analyzed statistically and the various parameters were correlated using Pearson's correlation., Results: There was a statistically significant correlation indicating that the growth of GB, QL and CL was proportional to the gestational age (GA). The variations in the morphology of the GB were also noted. In two specimens it was found that the GB was embedded partially in the substance of the liver and failed to reach the inferior border of the liver., Conclusion: The regression equations calculated in the study provide a tool to estimate the lengths of GB, QL and CL prenatally.

The traditional taxonomy of the genus Chloromyxum Mingazzini, 1890 has been intensively challenged to be paraphyletic by recent ribosomal DNA (rDNA)-based phylogenetic analysis. Undersampling to get rich sequence data to infer more scientific phylogenetic relationships makes scientists conservatively assign all non-marine elasmobranch-infecting species as Chloromyxum sensu lato. Although complex ridge pattern on the spore surface observed by scanning electron microscopy was thought to be critical for the identification of Chloromyxum species, insufficient data also prevent this ultrastructural data to be a valid taxonomic feature for this genus. It is especial for Chloromyxum species to be reported in China. Molecular and ultrastructural characteristics are yet available for all 22 Chloromyxum species recorded in China. During the investigation of the diversity of coelozoic fish myxosporeans, Chloromyxum ellipticum Li & Nie, 1973 was found to highly infect the gall bladder of Ctenopharyngodon idellus Valenciennes, 1844 in Poyang Lake watershed of Jiangxi province, Eastern China. Here, we redescribed it by the currently recommended holistic approach of combining morphological, ultrastructural, and molecular characteristics. Mature spores were found floating free in the gall bladder, but no plasmodium observed. Spores are typical freshwater teleost-infecting Chloromyxum species, spherical or subspherical in lateral view, measuring 7.7 ± 0.08 μm (6.9-9.1) in length, 6.3 ± 0.09 μm (5.6-7.6) in width, and 5.8 ± 0.20 μm (5.2-6.3) in thickness. Four pyriform polar capsules, located at the anterior end of the spores, were equal in size, 3.3 ± 0.06 μm (2.2-4.1) long and 2.1 ± 0.03 μm (1.7-2.5) wide. Polar filaments coiled with four to five turns. Two equal spore valves are symmetrical, with 10-16 surface extrasutural ridges per valve, aligned along the longitudinal axis. The obtained partial 18S rDNA of C. ellipticum did not match any sequences available in GenBank. Phylogenetic analysis showed that C. ellipticum clustered firstly with Chloromyxum legeri with robust nodal support and grouped then with urinary system of freshwater teleost-infecting Chloromyxum clade, rather than other gall bladder of freshwater teleost-infecting clade.

Background: Urgent laparoscopic cholecystectomy has been established as the best treatment for acute cholecystitis. However, conservative treatment is advocated for high-risk patients. Failure of conservative treatment can result in high-risk operations with relatively high rates of operative morbidity. Percutaneous cholecystostomy is a good option for these patients. Recently, percutaneous aspiration of the gall bladder without drain has been described., Methods: A protocol of initial conservative management in high-operative-risk patients admitted with acute cholecystitis was prospectively assessed. Patients who did not respond to antibiotics were treated with percutaneous trans-hepatic aspiration of the gall bladder under ultrasound guidance. Following discharge, the patients were seen in the outpatient clinic and elective laparoscopic cholecystectomy was considered and scheduled as necessary., Results: Between January 2011 and December 2012, 33 patients with persistent clinical and sonographic signs of acute cholecystitis after failure of initial antibiotic treatment underwent gall bladder aspiration under ultrasound guidance. No complications related to the procedure were reported. In 25 patients (76 %), the procedure was successful and they were discharged. Seven patients needed repeated aspiration. Eight patients (24 %) who did not improve underwent percutaneous cholecystostomy and were discharged with a drain and later reevaluated for elective surgery. The mean hospital stay of patients with successful aspiration was 3 days. During the follow-up period, 23 patients underwent elective interval laparoscopic cholecystectomy. Two were converted to open surgery (8.7 %)., Conclusions: Conservative treatment and delayed operation is an acceptable option for acute cholecystitis. Percutaneous gall bladder aspiration is a simple and effective procedure, with a high success rate and low morbidity. Laparoscopic cholecystectomy after drainage of the gall bladder has low morbidity with a relatively low conversion rate.

The first decade of the twenty-first century witnessed the presence and light microscopic, immunophenotypic, and ultrastructural characterization of interstitial Cajal-like cells (coined as 'telocytes') in virtually every extragastrointestinal site of the human body by Laurentiu M. Popescu and his co-workers. Not surprisingly, stromal tumours, immunophenotypically similar to that of telocytes [CD117 (c-KIT) +/CD34 +], have also been sporadically reported outside the tubular gut (so-called extragastrointestinal stromal tumours, EGISTs), including the gall bladder, liver, and pancreas. A meticulous literature search from January 2000 to November 2015 have found 9 such case reports of EGISTs in the gall bladder, 16 in the liver, and 31 occurring in the pancreas. The site wise mean age at presentation for these tumours were reported to be 62.2 ± 16.6, 50.9 ± 20.1, and 55.3 ± 14.3 years, respectively. Six of nine EGISTs in the gall bladder were associated with gallstones. On pathological evaluation, these tumours exhibited prominent spindled cell morphology and consistent expression of CD117/c-KIT and CD34 on immunohistochemistry and variable expression of vimentin and α-smooth muscle actin. The biological behaviour of hepatic and pancreatic lesions was favourable compared to that in the gall bladder, following definitive surgery with or without imatinib therapy. While the exact pathophysiologic role played by telocytes in various organs is yet to be fully elucidated, there seems to be a direct link between these enigmatic stromal cells and pathogenesis of gallstones and origin of EGISTs, and a hope for targeted therapies. Furthermore, the possible role of telocytes in hepatic regeneration and liver fibrosis opens a new dimension for futuristic research.

Bile is a biological fluid synthesized in the liver, stored and concentrated in the gall bladder (interdigestive), and released into the duodenum after food intake. The microbial populations of different parts of mammal's gastrointestinal tract (stomach, small and large intestine) have been extensively studied; however, the characterization of bile microbiota had not been tackled until now. We have studied, by culture-dependent techniques and a 16S rRNA gene-based analysis, the microbiota present in the bile, gall bladder mucus, and biopsies of healthy sows. Also, we have identified the most abundant bacterial proteins in the bile samples. Our data show that the gall bladder ecosystem is mainly populated by members of the phyla Proteobacteria, Firmicutes, and Bacteroidetes. Furthermore, fluorescent in situ hybridization (FISH) and transmission electron microscopy (TEM) allowed us to visualize the presence of individual bacteria of different morphological types, in close association with either the epithelium or the erythrocytes, or inside the epithelial cells. Our work has generated new knowledge of bile microbial profiles and functions and might provide the basis for future studies on the relationship between bile microbiota, gut microbiota, and health., (© 2014 The Authors. MicrobiologyOpen published by John Wiley & Sons Ltd.)

Opioid analgesics are widely believed to cause spasm of the bile duct sphincter and so impede bile flow. Thienorphine is a partial opioid agonist that is a good candidate for the treatment of opioid dependence; however, to date, no studies have reported the effects of thienorphine on the function of the biliary tract. This study examined the in vivo effects of thienorphine on the guinea pig isolated sphincter of Oddi, choledochus and gall bladder and on bile flow. The area under the curve (AUC) of isolated sphincter of Oddi was not influenced by thienorphine or buprenorphine, whereas morphine increased the AUC of the isolated sphincter of Oddi in a concentration-dependent manner. Thienorphine and buprenorphine concentration-dependently decreased the AUC of isolated choledochus, while morphine increased the AUC of isolated choledochus. Thienorphine had no effect on the contractile amplitude or basal tension of isolated gall bladder muscle strips. In contrast, buprenorphine and morphine increased the contractile basal tension of isolated gall bladder muscle strips in a concentration-dependent manner. Thienorphine (0.01-1.0mg/kg) had no significant inhibitory effect on bile flow. However, morphine (1.0-10mg/kg) and buprenorphine (1.0mg/kg) significantly inhibited bile flow. The maximum inhibition of bile flow by buprenorphine was 63.9±12.9% and by morphine was 74.1±11.3%. In summary, thienorphine has little influence on the guinea pig isolated sphincter of Oddi, choledochus and gall bladder or on bile flow, which may result in a lack of adverse biliary colic effects., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Peritonitis secondary to spontaneous rupture/perforation of the gall bladder is a rare condition overall and is even less common in the forensic population. We report the case of a middle-aged man who died from generalized peritonitis from gall bladder perforation due to acute acalculous cholecystitis. This condition usually occurs in critical patients with systemic illness, and although the exact pathogenesis remains unclear, the development of acalculous cholecystitis appears to be multifactorial. Antemortem diagnosis is reliant upon clinical presentation, laboratory data, and radiologic studies. Surgery and appropriate antibiotics are mainstays of treatment; however, there is an emerging role for minimally invasive procedures. Histopathologic features show significant overlap with the calculous type. Although increasing numbers of acalculous cholecystitis have been diagnosed in the critically ill, the fatal presentation of a perforated gall bladder following an undiagnosed case of acute acalculous cholecystitis is unusual in a nonhospitalized and ambulatory man., (© 2014 American Academy of Forensic Sciences.)

Objective: To validate the gall bladder wall thickness as a non-invasive marker for the prediction of esophageal varices (EV) in cirrhotic patients with portal hypertension. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: January 2024 to June 2024. Methods: Patients of age 18 years, of any gender diagnosed with cirrhosis and were endoscopy naïve with no previous history of intervention for varices were included. After an overnight fast, the gall bladder (GB) thickness was measured twice at two distinct places, and an average value was determined. Results: Total 210 patients were enrolled into the study with mean age of 56.3 ± 11.8 years. Majority were males (57.1%). Patients had comorbidity of hypertension (17.1%) and diabetes (16.2%). Median gall bladder thick was 2.3 (IQR=1.2-2.9) cm. AUC for GB to predict EV was found to be 0.983 (95% CI: 0.96-1, p<0.001) which shows excellent predictive ability of GB thickness. The optimal cut-off value of GB thickness was found to be ≥1.95 cm. On multivariable regression analysis, increasing gall bladder thickness was found to be associated with higher odds of esophageal varices. Conclusion: The present demonstrated that GB thickness is a promising parameter with excellent predictive ability for prediction of EV among cirrhotic patients with portal hypertension, which should be included in part of routine evaluation in such cohort of patients for timely detection of EV. [ABSTRACT FROM AUTHOR]

Background/Objectives: Growing evidence suggests that cholecystectomy is associated with adverse health outcomes, including the development of metabolic diseases. However, data on the association between cholecystectomy and kidney disease are limited. The present study aimed to investigate the association between cholecystectomy and chronic kidney disease (CKD) using a nationwide longitudinal cohort. Methods: Participants aged ≥20 years with cholecystectomy between 2010 and 2014 (n = 116,748) and age- and sex-matched control participants without cholecystectomy (n = 116,748) were analyzed using the Korea National Health Insurance Service data. The adjusted hazard ratios (aHRs) were calculated for incident CKD in the cholecystectomy group compared with the nonoperative controls. Results: A total of 233,496 participants were included (mean age, 54.7 ± 12.7 years; 52.6% men). During the mean follow-up period of 4.8 ± 1.7 years, 6450 patients (5.5%) were newly diagnosed with CKD in the cholecystectomy group. Cholecystectomy was an independent risk factor for the development of CKD after adjustment for confounders, including age, sex, income, health behaviors, and comorbidities. The risk of CKD was 21% higher in the cholecystectomy group compared to the non-cholecystectomy group (aHR, 1.21; 95% CI, 1.17–1.26). The increased risk of CKD in the cholecystectomy group was consistently significant when a stratified analysis by age, sex, and presence or absence of comorbidities was conducted. Conclusions: Cholecystectomy was independently associated with an increased risk of developing CKD in a nationwide population-based study. Therefore, careful and long-term monitoring of the risk of CKD after cholecystectomy is necessary. [ABSTRACT FROM AUTHOR]

Introduction: Gallbladder is one of the most frequently received specimens in any histopathology laboratory. Its diseases may present with a varied spectrum ranging from congenital anomalies, cholelithiasis, and inflammatory or noninflammatory lesions to noninvasive and invasive neoplasms. Cholelithiasis (gallstones) is the most common lesion and accounts for more than 95% of gallbladder diseases and affects 10%–20% of the adult population. The incidence is 2–4 times higher in females than in males. Aims and Objectives: This study was designed to study the histopathological spectrum of gall bladder diseases in the population, study the most common gall bladder diseases in cholecystectomy specimens, and study the frequency of gall bladder carcinoma. Methodology: This retrospective observational study was done in the Pathology department at a tertiary care hospital and research center, from September 2016 to September 2023. Tissue was fixed in 10% buffered formalin and then processed by the routine paraffin embedding techniques. Sections were cut at 4–5 μ thickness and stained with hematoxylin and eosin stains. Special stains were done if required for confirmation. All the slides were analyzed and reported by a trained histopathologist. Results: Females were affected more as compared to males. The commonest age group affected was 41-50 years. Gallstones were observed in 33.58% of patients. Gallbladder neoplasm was rare and incidental findings. Conclusion: Gallbladder disease demonstrated a diverse spectrum of histopathological changes in the cholecystectomy specimens and showed female preponderance. Gallbladder carcinoma was observed as a rare occurrence and was an incidental finding mainly. Hence, a microscopic (histopathological) examination is required for every cholecystectomy specimen. [ABSTRACT FROM AUTHOR]

Background- In modern era increasing interventional and diagnostic procedures and laparoscopic cholecystectomy make study of variation in external morphology of gall bladder important variation of morphology of gall bladder commonly encounter during radiological investigation a during surgeries. Aim and Objective: To Study of Variations in External Morphology of Gall Bladder in Cadavers. Material and Method: Study was conducted on 100 gallbladder obtained from formalin fixed cadavers. Shape length and transverse diameter of gall bladder studied. Result: Commonest shape observed in this study was pear shaped in 82% cases. Average length of gallbladder was found to be 6.54cm. Conclusion: - Variation in extra hepatic billiary in not uncommon. Knowledge of this variation important for surgeon and radiologist for avoid iatrogenic injuries during procedures. [ABSTRACT FROM AUTHOR]

Metastasis to the heart is uncommon compared to other organs, posing notable diagnostic challenges. Incidence in autopsy studies typically ranges between 0.7% and 3.5%. Lung, breast, and hematologiccancers are the main sources of such metastases, leading to varied clinical presentations and severe complications. Postmortem viscera from a 47 year old male with a suspected history of jaundice. Only limited information was available. Gross examination showed a solid mass in the gall bladder with areas of hemorrhage and necrosis, while no other abnormalities were observed in other viscera received. Brain examination showed congested blood vessels, while heart sections exhibited atypical cell deposits in the pericardium and myocardium. Coronary arteries displayed pathological thickening. Lung and liver sections also displayed similar metastatic atypical cell deposits, infiltrating tissue and causing necrosis. Gall bladder examination revealed irregular glandular formations lined with polygonal tumor cells positive for cytokeratin. The final diagnosis based on histomorphological features and immunohistochemistry confirmed gall bladder adenocarcinoma metastasising to the heart, liver and lungs. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Cystic artery pseudoaneurysm is a rare phenomenon associated with cholecystitis. We describe the successful management of angioembolisation and cholecystectomy. Cystic artery pseudoaneurysm (CAP) is a rare but clinically significant condition with various etiological factors. Cholecystitis is a prominent cause, often leading to inflammation‐induced arterial wall erosion and pseudoaneurysm formation. CAP can present with a range of symptoms, including hemobilia, upper GI bleeding, and jaundice. Despite its rarity, CAP warrants attention in emergency care due to its potential for life‐threatening arterial bleeding. Timely diagnosis is crucial, with imaging techniques playing a key role. Depending on the clinical context, management options include endovascular embolization and surgical intervention. Due to the limited cases, standard protocols remain elusive. A 64‐year‐old woman presented with abdominal pain, anorexia, and weight loss, prompting an evaluation for possible gallbladder cancer. She experienced sudden abdominal pain and upper gastrointestinal bleeding (hematemesis). Laboratory findings revealed leukocytosis, anemia, and abnormal liver function tests. Imaging showed gallbladder wall thickening, luminal contraction, and a pseudoaneurysm in the cystic artery. The patient underwent angioembolization followed by cholecystectomy, confirming acute cholecystitis and CAP with thrombosis. This case underscores the importance of early recognition and appropriate management in CAP, particularly when accompanied by acute cholecystitis. [ABSTRACT FROM AUTHOR]

Aim and objectives: The surgeon must recognize variations in the gallbladder, bile ducts, arteries that supply them, and liver to prevent unintentional ductal ligation, biliary leaks, and strictures after cholecystectomy. This study's objective was to investigate the structural changes that take place in the extrahepatic biliary tree and vasculature after cholecystectomy by comparing pre- and post-operative images. Materials and method: This Prospective Intraoperative observational study was conducted in the department of General Surgery, Santosh Medical College and Hospital from July 2021 to June 2022. The sample size was calculated to be 139 patients. Common Hepatic Duct formation, Right and left hepatic duct union, Types of cystic-hepatic duct union, Cystic duct and common hepatic duct, duct length, Hepato-duodenal ligament structures, Ductal variations, Arterial, duct, and Calot's triangle variations. Results: Majority (31.8%) belonged to 26-35 years followed by 36-45 years (29.1%), 46-55 years (18.9%), Above 55 years (10.8%) and 15-25 years (9.5%). There were 26.4% males and 73.6% females. Calot was frozen among 23.0% and Accessory artery in calot was found among 2.0% subjects. The anomalies were Aberrant right hepatic artery (0.7%), Accessory artery (1.4%), Double cystic duct (0.7%), Empyema (8.8%), Gb polyp (0.7%), Micro Gallbladder (0.7%), Mucocele (1.4%), Necrosed gall bladder (1.4%), Phregian cap (0.7%), Pyocele with moynihan hump (0.7%) and Type 2 bile duct injury (0.7%). Conclusion: Short cystic duct and intrahepatic gall bladder alterations are most common. Cholecystectomy discloses extrahepatic biliary problems. Every surgeon should watch for these variations to avoid unintended ductal cutting, ductal injuries, and haemorrhage during laparoscopic and open cholecystectomy. [ABSTRACT FROM AUTHOR]

Background: Dengue Fever (DF), Dengue Hemorrhagic Fever (DHF), and Dengue Shock Syndrome are among the disorders caused by the Dengue virus. Objective: The purpose of the present study was to assess severity of dengue by ultrasound findings and to correlate the ultrasound findings with blood platelet count. Methodology: This prospective study was conducted in the at Dr. MR Khan Shishu Hospital & ICH, Dhaka, Bangladesh from May 2019 to October 2019. Total 107 dengue children patients aged from 0 to14 years old were selected as a study population. Purposive sampling technique was used. Data were collected with pre-tested, modified and structured questionnaire. Complete blood count/picture (CBC), Laboratory based serological tests and Ultra sonographic test were performed. Results: USG studies were performed on all patients with severe dengue fever. Most of the dengue patients had blood platelet counts under 100000. USG studies revealed that Pericholecystic collection was the most common finding in dengue patients followed by thickening of GB, pleural effusion, pelvic collection, peri renal collection and ascites. In this study there was positive correlation between sonographic findings with platelet count of Dengue fever in children. The Mean and SD of platelet count was 56635.51±26267.633. Paired Samples correlations of sonographic finding with platelet findings were positively correlated but paired difference and t test result was significant. Clinical features and thrombocytopenia are help in lead us to the diagnosis of dengue. There were 86.92% patients had platelet counts under 100,000. There was positive correlation between sonography findings and platelet count. About 95.33% of the patients had Pericholecystic collection and 92.50% had GB Wall edema. Conclusion: in conclusion, USG abdomen showing Pericholeystic collection and GB wall edema is a useful marker for early diagnosis of severe Dengue Fever. [ABSTRACT FROM AUTHOR]

Background: To evaluate and compare efficacy of laparoscopic cholecystostomy and interval cholecystectomy versus open cholecystectomy in cases of difficult gallbladder. Materials and Methods: This study will be conducted in Department of General surgery, Kamineni Hospital, Hyderabad between October 2012 to December 2014. The facilities, expertise and the necessary Infrastructure are available in this hospital. A comparative observational study, which included 40 patients of difficult gallbladder who needs cholecystectomy. Ethics committee's permission has been taken. Results: In the present study, there were difficulties associated with Laparoscopic cholecystostomy like subjecting the patient to a second surgery, carrying a drain, longer hospital stay and increased expenditure. Laparoscopic cholecystostomy followed by Interval chole-cystectomy was safe with less postoperative morbidity associated with faster patient recovery and satisfaction as documented by less postoperative pain, earlier resumption of oral feeds, earlier full mobilization and discharge home, as well as lesser complication rate with least possible scar. Conclusion: In conclusion, the study supports the view that laparoscopic cholecystostomy followed by interval cholecystectomy is safer and efficacious and offers definitive advantages over open conversion and should be an available option for all patients requiring emergency cholecystectomy. [ABSTRACT FROM AUTHOR]

The paper presents the results of research of diagnosis and stage determination peculiarities of cholecystitis in dogs. In general, the clinical, differential diagnostic and ultrasonographic stages of the course of cholecystitis were studied. An important clinical and diagnostic tool for the diagnosis of cholecystitis in dogs is the application of the ultrasonographic examination. The study included 64 dogs, which were examined to diagnose cholecystitis. Three groups of dogs were identified: 17 dogs (27% of cases) were affected with initial stage of cholecystitis, 26 dogs (40% of cases) were affected with intermediate and 21 dogs (33%) were affected with late stage. The main clinical symptoms of the first stage of the gallbladder inflammation consisted of anorexia, vomiting, abdominal wall pain. The ultrasonographic picture was characterized by the presence of a hyperechoic wall of the gallbladder, an increase in the thickness of its wall, and a thickening of the mucous layer. Following mentioned symptoms including anorexia, weight loss, the presence of vomiting, decreased skin turgor, icterus of the mucous membranes, and abdominal wall pain were chosen as the main clinical symptoms of the 2nd stage of the gallbladder inflammation. Morphological signs that were selected for the diagnosis of cholecystitis were investigated by ultrasonography, including the presence of the wall hyperechoicity, thickening of the gallbladder wall, thickening of the mucous membrane layer, the presence of a suspension (mucocele) in the gallbladder and hyperechoic calculi. Presence of anorexia, a decrease in body weight, the presence of vomiting, a decrease in skin turgor, icterus of the mucous membranes, tenderness of the abdominal wall during palpation were chosen as the main clinical symptoms of the 3rd stage of gallbladder inflammation. During the 3rd stage of cholecystitis in dogs, the following signs were determined by ultrasonography: hyperechogenicity and heteroechogenicity of the gallbladder wall, thickening of the mucous membrane of the gallbladder; the presence of erosions on the mucous membrane, the presence of mucocele and hyperechoic calculi up to 5-7 mm in the gallbladder. [ABSTRACT FROM AUTHOR]

Heterotopia is defined as the presence of a tissue outside of its natural location. Ectopic or heterotopic pancreatic tissue is a form of choristoma and is considered an embryological abnormality. Stomach, duodenum, jejunum and spleen are common localizations. The gallbladder is a very rare localization. In this case report, ectopic pancreatic tissue observed in the gallbladder of a 41-year-old patient who is diagnosed with chronic calculous cholecystitis who underwent surgery is discussed in the light of current literature. [ABSTRACT FROM AUTHOR]

Gallstone-related disease comprises a spectrum of conditions resulting from biliary stone formation, leading to obstruction and inflammatory complications. These can significantly impact patient quality of life and carry high morbidity if not accurately detected. Appropriate imaging is essential for evaluating the extent of gallstone disease and assuring appropriate clinical management. Magnetic Resonance Imaging (MRI) techniques (including Magnetic Resonance Cholangiopancreatography (MRCP) are increasingly used for diagnosis of gallstone disease and its complications and provide high contrast resolution and facilitate tissue-level assessment of gallstone disease processes. In this review we seek to delve deep into the spectrum of MR imaging in diagnose of gallstone-related disease within the gallbladder and complications related to migration of the gallstones to the gall bladder neck or cystic duct, common hepatic duct or bile duct (choledocholithiasis) and beyond, including gallstone pancreatitis, gallstone ileus, Bouveret syndrome, and dropped gallstones, by offering key examples from our practice. Furthermore, we will specifically highlight the crucial role of MRI and MRCP for enhancing diagnostic accuracy and improving patient outcomes in gallstone-related disease and showcase relevant surgical pathology specimens of various gallstone related complications. [ABSTRACT FROM AUTHOR]

Introduction: Limy bile or milk of calcium bile caused due to precipitation of calcium salts in bile is an extremely rare condition of gall bladder, wherein the lumen of gall bladder is filled with chalky white paste like material. Not many cases have been reported till date. Aim: In this exceptional case, we tried to correlate the radiological and surgical findings with the histopathology. Case study: We hereby present an interesting case of a 59-year-old male who presented with dyspepsia and painful abdomen and was finally diagnosed with limy bile syndrome. Results and discussion: The etiology of this rare entity is not fully understood, but it certainly has strong association with impacted stone at the neck of gall bladder and hyperparathyroidism. Females are more commonly affected than males. Patients usually present with complaints of painful abdomen and are commonly diagnosed radiologically, as a radiopacity in gall bladder. Cholecystectomy is the preferred method of treatment for this unusual condition and histopathologically chronic cholecystitis is seen along with presence of slender needle shaped crystals of calcium salts. Conclusions: A thorough evaluation of the clinicoradiological and histopathological findings can sometimes bring to light many uncommon variants of common looking pathologies. [ABSTRACT FROM AUTHOR]

BACKGROUND: Gallbladder is one of the organs having a wide spectrum of diseases ranging from calculi and its complications, non-inflammatory, inflammatory to the neoplastic lesions. AIMS AND OBJECTIVES: The aim is to study histopathological spectrum of various gall bladder lesions. MATERIALS AND METHODS: It was a prospective study carried out from March 2023 to August 2023. A series of 149 cholecystectomies specimen were examined grossly and histopathologically. RESULTS: In our study, out of the 149 cases the most common histopathological lesion of gall bladder was chronic cholecystitis with cholelithiasis i.e. 113 cases (75.8%). Chronic cholecystitis without cholelithiasis was seen in 18 cases (12.0%), acute on chronic cholecystitis was seen in 14 cases i.e. 9.3%, adenocarcinoma of gall bladder was seen in 02 cases i.e. 1.3% and adenosquamous carcinoma was seen in 0.6%. CONCLUSION: Gallbladder histopathology includes a variety of lesions. These findings were more common in females and present mostly in the 3rd to 5th decade of life. Most common histopathological finding was chronic cholecystitis and most of the lesions of gallbladder were associated with gallstones. It must be noted that prompt detailed histopathological analysis of the cholecystectomy specimens will help to confirm the benign nature of the disease or to detect any precursors of malignancy [ABSTRACT FROM AUTHOR]

Background: Gall bladder specimens are the most commonly encountered specimens in histopathology. The disease spectrum varies from inflammation to malignancy. Aims and objectives: The aim of the present study is to study the spectrum of diseases encountered during histopathology. Material and Methods: The study included total of 91 cases over a period of 1 year. Hematoxylin and Eosin stained sections of all cases were examined. Results: The most common histological diagnosis was chronic cholecystitis (46/91). Thirty seven (37) cases were diagnosed as Acute on chronic cholecystitis. Four (4) cases were reported as Xanthogranulomatous cholecystitis, 2 as Adenocarcinoma, 1 as gangrenous cholecystitis and 1 as follicular cholecystitis. Conclusion: Most commonly diagnosed disease in cholecystectomy specimens was Chronic cholecystitis followed by acute on chronic cholecystitis. Histopathological examination plays an important role as sometimes chronic long standing inflammation may leads to malignancy as I our scenario. Two cases turned out adenocarcinoma which were clinically and radiologically diagnosed as chronic cholecystitis. [ABSTRACT FROM AUTHOR]

Laparoscopic cholecystectomy is gold standard for gall stone disease. For a successful surgery, need a good patient selection. We Have observed numbers of situations where conversion to open surgery occurred, this is probably due to operation in a compromised vision, difficulty in holding structure and lack of tectile sensation. Conversion rates varies from 5-10% in different centers. So, if one can preoperatively predict the difficult gall stone disease, the comorbidity, iatrogenic injury and cost of treatment will be definitely decrease. Methods A retrospective study was carried out in department of general surgery, VIMSAR, Burla. All patients who have underwent elective laparoscopic cholecystectomy irrespective of age between Jan 2018 to Jan 2022 were included in this study. Exclusion criteria - Patients with acute cholecystitis, CBD stone, dilated CBD(>6mm) are excluded from this study. Bed head tickets of all operated patient are retrieved from the store office and after thorough study of the notes, the preoperative score according to Randhawa and Pujahari scoring system done. The following parameters were recorded from the operative notes —time taken for surgery, bile/ stone spillage, injury to cystic duct or cystic artery, conversion to open cholecystectomy. After analyzing all the parameters, we defined the surgical procedure as easy, difficult and very difficult. Results: Hundred patients were included in our study and out of them male 24 and female 76. 73 patients were in the age group of < 50yrs and 37 patients were > 50 yrs. BMI < 25 in 47 patients, 34 in 25.1 - 27.5 and 19 in > 27.5. 43 patients have previous history of surgery and among them tubectomy (24), lower (uterine) segment cesarean section (11) and duodenal perforation (8). Except 3 patients (who have supraumbilical scar) rest have infra umbilical scar. 30 patients have previous history of hospitalization and among them acute cholecystitis ( no patients have h/o jaundice) or biliary colic. Gall bladder was palpable in 20 patients. GB wall thickened in 21 patients. Impacted stone noted in 19 patients. Conclusion: In our hundred cases, we found that sex, BMI, previous history of hospitalisation, palpable GB and thickened GB wall were found statistically significant in predicting difficult laparoscopic cholecystectomy and among them previous history of hospitalisation and GB wall thickness have statistically highly significant. Laparoscopic surgeons may use this scoring system for preoperative prediction of difficult LC. To know the accurate accuracy of the scoring system, large sample operated by preferably single expert surgeon is needed. [ABSTRACT FROM AUTHOR]

Introduction: Non-alcoholic fatty liver disease (NAFLD), cholecystitis and gallstones are important problems of public health which are associated with high fat diet intake and hypercholesterolemia. Capsaicin (CAP) is widely used in clinical practice. It can prevent obesity and lower blood lipids. Aim of the Work: To clarify the possible protective role of Capsaicin against the effects of high fat diet (HFD) on the liver and gall bladder using histological and immunohistochemical examinations and real time polymerase chain reaction (PCR). Material and Methods: Thirty-two healthy adult male mice were separated into four groups. Control group: Animals were fed normal chow diet for 8 weeks. CAP group: Animals were fed normal chow supplemented with 0.01% CAP. HFD group: Mice were fed HFD for 8 weeks. HFD + CAP group: Animals were fed HFD supplemented with 0.01% CAP for 8 weeks. At the end of the study period, animals were weighed, anesthetized, blood samples were collected and abdomens were opened. Liver and gall bladder were removed for histological preparation. H&E, Masson, Cyclooxygenase-2 (COX-2) immunohistochemically-stained sections and ORO-stained frozen liver section were examined. Results: Ballooned and degenerated hepatocytes, thickened stratified hyperplastic gall bladder epithelium and inflammatory aggregations were observed in HFD group. Excess collagen fibers and strong positive COX-2 immunoreaction were also seen. Mean values of lipid profile levels, Peroxisome proliferator-activated receptor gamma (PPAR γ) and 3-hydroxy-3- methylglutaryl coenzyme-A (HMG CO-A) reductase gene expression group revealed an increase of very high significant difference from the control group. A decrease in these mean values was reported in HFD+CAP group which was of a very high significant difference from HFD and control groups. Normal hepatic and gall bladder architecture was markedly preserved in HFD+CAP and immunoreaction to COX2 was weak. Conclusion: CAP is suggested to have a great protective effect against HFD-induced histological changes in the liver and gall bladder through downregulating PPAR γ and HMG CO-A reductase gene expression and by acting as anti-fibrotic and anti-inflammatory agent. [ABSTRACT FROM AUTHOR]

Background: The present study was conducted for carrying out histopathological assessment of gallbladder mucosa among gallstone patients. Materials & methods: 100 gallstone patients were enrolled. Gross examination of size of gallstones was done. The gallbladder mucosal tissue was properly sampled and processed by routine histological techniques by hematoxylin and eosin staining of the sections. The various morphological responses were then categorized into four broad categories - cholecystitis, hyperplasia, metaplasia, and carcinoma. Results: Chronic cholecystitis was the diagnosis in 81 percent of the patients while chronic cholecystitis with hyperplasia was the diagnosis in 11 percent of the patients. Chronic cholecystitis with metaplasia was the diagnosis in 5 percent of the patients while papillary carcinoma was the diagnosis in 3 percent of the patients. While assessing the correlation of histopathologic diagnosis with gallstone size, significant results were obtained. Conclusion: As the gallstone size increases, the reaction in the gallbladder mucosa changes from cholecystitis, hyperplasia, and metaplasia to carcinoma. Chronic cholecystitis is the most common histopathological diagnosis and 3 % patients had incidental Gall bladder carcinoma [ABSTRACT FROM AUTHOR]

Background: To analyse histopathological findings of gallbladder mucosa among gallstone patients undergoing laparoscopic cholecystectomy Materials & methods: 200 gallstone patients were enrolled. Laparoscopic cholecystectomy was done in all the patients and gallbladder mucosal specimens were obtained. Samples were properly sampled and processed by routine histological techniques by hematoxylin and eosin staining of the sections. The various morphological responses were then categorized into four broad categories - cholecystitis, hyperplasia, metaplasia, and carcinoma. SPSS software was used for analysis. Results: On histopathologic examination, chronic cholecystitis was the diagnosis in 79 percent of the patients while chronic cholecystitis with hyperplasia was the diagnosis in 11.5 percent of the patients. Chronic cholecystitis with metaplasia was the diagnosis in 7.5 percent of the patients while papillary carcinoma was the diagnosis in 2 percent of the patients. Conclusion: Gallstones produce diverse histopathological changesin the gallbladder including hyperplasia, metaplasia and carcinoma. [ABSTRACT FROM AUTHOR]

A comparative gross morphological and histological study on the gall bladder Bakerwali and non-descript goats of union territory of Jammu and Kashmir, India, was conducted. Biometrical values were significantly higher in Bakerwali goats as compared to non-descript goats of the Jammu region. Length showed an increasing pattern with advancing age in both breeds. Mean length was more in Bakerwali goat as compared to non-descript. Mean width within the adult age group of Bakerwali and non-descript goats showed a significant difference (p ≤ 0.05). Mean width was significantly more in Bakerwali goat as compared to non-descript. Mean values of width and thickness of gallbladder were found lesser in senile age groups irrespective of breeds. In the neck region of the gall bladder, serous glands were observed in Bakerwali goats whereas, in the body and fundus region, mucous glands were predominant. In non-descript goats, the glands were predominantly mucous type irrespective of the region of the gallbladder. All the micrometrical values showed non-significant differences between the breeds (p ≤ 0.05). [ABSTRACT FROM AUTHOR]

Background: Liver cirrhosis is defined pathologically as fibrosis and inflammation of the liver which is caused by chronic HBV, chronic HCV, NASH, NAFLD, chronic alcohol use and auto immune diseases which lead to portal hypertension. Aim and Objectives: The aim of this study is to evaluate whether non-inflammatory gall bladder wall thickness serve as predictor of oesophageal varices in combination and comparison with other non-invasive clinical and laboratory parameters. Subjects and Methods: This case-control study was conducted at the Hepatology and Gastroenterology Department, Ain Shams University, Egypt. The study was conducted over a period of one year, from January 2022 until January 2023. Result: There was no statistically significant difference between both groups as regard age, sex and associated comorbidities. There was statistically significant higher rate of clinical findings either gastrointestinal or systematic in subjects with esophageal varices that those without varices. 37.78% of subjects with cirrhosis without esophageal varices have normal clinical examination. Conclusion: According our study, measuring gallbladder wall thickness is very useful for detection of esophageal varices in cirrhotic patients aswe find significant association between gallbladder wall thickness and liver cirrhosis patients with esophageal varices. GBWT improve the non-invasive monitoring of liver disease patients to assess the risk for the presence of EV. [ABSTRACT FROM AUTHOR]

Objective: To compare the incidence of port-site hernia with and without use of dilator for extraction of gall bladder in elective laparoscopic cholecystectomy. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Bahawalpur Pakistan, from Oct 2019 to Oct 2021. Methodology: Sixty patients scheduled to undergo laparoscopic cholecystectomy were included in the study based on the inclusion and exclusion criteria. Patients were divided into two equal groups (n=30). Group-A included patients in whom dilator was used and Group-B had those patients in whom dilator was not used. All patients were followed up by clinical examination for development of hernia at the port-site for extraction of gall bladder for 18-24 months postoperatively. Frequency of clinical development of gall bladder extraction port-site hernia was noted for every group. Result: Mean age of the patients was 42.90±14.12 years with an age range of 22 to 85 years. Of all the patients 9(18%) were male and 51(82%) patients were females. In Group-A, one patient developed port-site hernia clinically whereas in Group-B no patients developed this condition. The p-value was found to be 0.31. These results are statistically insignificant showing that use of dilator in elective laparoscopic cholecystectomy does not increase the incidence of port-site hernia significantly. Conclusion: Use of dilator does not significantly affect the incidence of development of port-site hernia from where gall bladder is extracted. [ABSTRACT FROM AUTHOR]

Gallbladder (GB) Small Cell Carcinoma (SCC) is an uncommon entity with very poor prognosis. There is a paucity of literature regarding its natural history and management, with only 73 prior cases reported in the world literature. In this case report, we present three cases of SCC of the GB with varied presentations, clinical course, management, and outcomes along with a brief review of the available literature on this subject. [ABSTRACT FROM AUTHOR]

A 3‐year‐old, female, Nigerian dwarf goat presented for the evaluation of a swelling in the right flank. No other clinical signs were apparent. Biochemical changes were minimal and included a hyperfibrinogenemia and a leukocytosis characterised by neutrophilia. Diagnostic imaging included ultrasonography and computed tomography, which demonstrated a grossly distended gall bladder. Cholecystectomy could not be performed due to extensive adhesions, so the case was managed successfully via tube cholecystostomy, lavage, open drainage and systemic antibiotics for 5 weeks. Eight months after treatment, the goat continues to gain weight and is clinically well otherwise. Although rare, the successful treatment of septic cholecystitis is possible in goats. [ABSTRACT FROM AUTHOR]

Occurrence of small-vessel occlusions (thrombotic microangiopathy, TMA) in association with antiphospholipid antibodies (aPL ab) has been documented. But isolated involvement of gall bladder due to TMA in secondary aPLS (antiphospholipid syndrome) in post-partum status has been unreported. aPL and systemic lupus erythematosus (SLE) are two closely related diseases that not only share lupus susceptibility genes but can also produce thrombosis. Here we present a young lady, recently delivered with SLE experiencing moderate to severe right abdominal pain and occasional vomiting. A hepatobiliary iminodiacetic acid (HIDA) scan revealed non visualization of gall bladder (GB) confirming the diagnosis of acute acalculous cholecystitis (AAC). Investigations revealed high titre of anti-ß2 glycoprotein I (ß2GPI) IgG and anti-Cardiolipin (aCL) IgG antibodies confirming aPL syndrome. Antinuclear antibody, double-strand dsDNA was found to be positive confirming SLE. Open cholecystectomy was performed and histology revealed AAC, vasculitis with small vessel ischemia of gallbladder. GB non visualization on HIDA scan (ACC) due to solitary thrombotic microangiopathy of GB is being highlighted in this case of active SLE and secondary aPLS. Early diagnosis is mandatory to avoid repetitive thrombotic occlusions in active cases of SLE with aPLS. [ABSTRACT FROM AUTHOR]

The histochemical examinations of the gallbladder were performed on 12 guinea-fowl (Numida meleagris) birds. The fundus of the gallbladder shows mild periodic acid Schiff (PAS) positive activity for glycogen at the brush border of the epithelium in the mucosal layer, while the body of the gallbladder shows mild PAS activity at the brush border of the epithelium and lamina propria in the mucosal layer, and exhibits strong PAS activity for glycogen in the neck of the gallbladder. Very high activity of acid phosphatases was detected in the brush border of epithelium at mucosal layer in fundus portion, modest acid phosphatases activity was noted in the brush border of epithelium at mucosal layer in body part, mild activity was extended into circular muscle fibers of neck portion. In addition to epithelium, some lamina propria, and circular muscle fibers in the fundus and body portions, mild alkaline phosphatase activity were also seen in the neck portion's tunica adventitia and epithelium. [ABSTRACT FROM AUTHOR]

Peritonitis by perforation of the gall bladder of typhic origin is a rare condition. In Côte d'Ivoire, no studies to our knowledge have addressed the vesicular complications of typhoid fever in children. The aim of this work was to describe the epidemic-clinical, therapeutic and evolutionary aspects of the perforation of the gall bladder of typhic origin in subjects under 15 years of age. In 6 years, five children showed a vesicular perforation of typhic origin or 9.4% of peritonites of typhic origin. They were 5 boys with an average age of 07.4 years 5–11 years. The children were from low socioeconomic backgrounds. No history was noted. Clinical examination revealed peritoneal syndrome. X-ray of the abdomen without preparation carried out in all children had objectified a diffuse greyness. Leucocytosis was present in all cases. Treatment in all children initially consisted of resuscitation and antibiotic therapy with the 3rd generation cephalosporin and an imidazole. Surgical exploration revealed gangrene and perforated gallbladder without damage to other organs or the presence of stones. A cholecystectomy was performed. The following procedures were simple in 4 patients. A patient died of sepsis following postoperative peritonitis by biliary fistula. Perforation of the gall bladder of typhic origin is rare in children. It is usually discovered at the stage of peritonitis. The treatment combines antibiotic therapy and cholecystectomy. Systematic screening should reduce the progression to this complication. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the outcome after laparoscopic cholecystectomy in terms of these complications in our setup. Study Design: Descriptive Cross-sectional study. Setting: Department of General Surgery, MTI-Lady Reading Hospital Peshawar. Period: July 2018 to June 2019. Material & Methods: A total of 115 patients undergoing laparoscopic cholecystectomy were enrolled in this study and were assessed for the development of various postoperative complications. Results: The mean ± SD age of study participants was 45.92±5.41 years. Females (n=67; 58.2%) outnumbered males (n=48; 41.7%) in this study. Most common complication was port site infection noted in 7 patients (6.1%) with gall bladder perforation being second most common complication observed in 6 patients (5.2%). Post-operative fever was noted in 4 patients (3.5%). Conclusion: In our study the majority of patients undergoing laparoscopic cholecystectomy recovered uneventfully without any mortality. Port site infection was the most common complication and gall bladder perforation was found to have statistically significant association with all the complications. [ABSTRACT FROM AUTHOR]

Background: Carcinoma of the gall bladder (Ca GB) has marked ethnic and geographical variations with a broad spectrum of imaging findings on multidetector-row computed tomography (MDCT). We aim to study the spectrum of the imaging findings of Ca GB on MDCT in an Eastern Indian hospital as these imaging findings help in accurate diagnosis and staging of this lethal disease. Materials and Methods: The MDCT images of 100 biopsy-proven cases of adenocarcinoma of GB performed from January 1, 2017, to December 31, 2018, in our hospital were retrospectively reviewed by two experienced radiologists blinded to the diagnosis. The CT protocol was a plain scan followed by triple-phase contrast-enhanced CT. Reconstructed images in the form of maximum intensity projection, volume-rendered technology, and minimum intensity projection images were also assessed. Descriptive statistics were used for data analysis. Results: Ca GB showed a female predominance (female:male –1.9:1). The mean age of presentation was 54.7 years (females) and 58 years (males). The morphological patterns were a mass replacing the GB (46%), focal or diffuse wall thickening (26%), and an intraluminal polypoidal mass (28%). Direct extension was to liver (76%), duodenum (32%), colon (19%), pancreas (9%), and abdominal wall (1%). Biliary dilatation (53%), vascular invasion (14%), omental involvement (23%), ascites (22%), N1 (40%), and retroperitoneal lymphadenopathy (33%) were common. Distant metastasis comprised of hepatic (42%), pulmonary (7%), Krukenberg's tumor (6%), and osseous (1%) lesions. The stages at diagnosis were I or II (3%), IIIA (4%), IIIB (16%), IVA (10%), and IVB (67%). Conclusions: Ca GB has a broad spectrum of findings on MDCT and it mostly presents at an advanced stage. MDCT with reconstructions is beneficial in the assessment of locoregional and distant spread and cancer staging which has a direct implication on patient management, survival, and mortality. [ABSTRACT FROM AUTHOR]

Introduction: Currently, there are no randomized controlled trials published up-to-date to give us level-1 evidence that CVS prevents bile duct injuries. Therefore, the present study focuses on various pre-operative parameters that effect to achieve the critical view of safety during laparoscopic cholecystectomy. Material and Methods: This prospective study was conducted in 50 patients presenting to the Department of General Surgery for Laparoscopic cholecystectomy. All patients included in this study were thoroughly clinically examined and ultrasonographic evaluation of gall bladder and hepatobiliary, pancreatic system was done followed by routine blood investigations. A Probability value (p value) less than 0.05 was considered statistically significant. All statistical calculations were done using SPSS (Statistical Package for the Social Science) Version 21.0 for Microsoft Windows. Results: Maximum number of patients were in the age group of > 41 years (52 %) followed by 31-40 years age group.Mean age of the patients of the present study was 41.14+12 years. Female patients (82%) outnumbered the male (18%) patients in our study. Most common presenting complaint was pain abdomen in 40 out of 50 patients followed by dyspepsia (26) and post meal fullness (26). 43 patients (86%) had multiple gall stones while 7 patients (14%) had single gall stone. Conclusion: Pre operative ultrasound findings suggestive of stone impacted in the neck of the gall bladder were associated with intra operative presence of adhesions between gall bladder and surrounding structures, thus making it difficult to achieve critical view of safety. [ABSTRACT FROM AUTHOR]

Background:Gall bladder diseases are a very common health problem that affects millions of people throughout the world. Cholelithiasis is commonly associated with carcinoma gallbladder. Cholecystectomy is the most commonly performed surgical procedure done for gall bladder disease.Material and Methods:A total of 1870 cases of gall bladder lesions were evaluated from September 2016 to August 2021 which were sent to department of pathology. Specimens were fixed in 10% formalin. Appropriate areas were selected from the specimen and grossed, processed, sectioned, stained using haematoxylin and eosin and were observed under microscope.Results:Out of 1870 cases, 1520 were female (81.28%) and 350 cases were male (23.02%). Histopathologically, the most common diagnosis was Chronic calculus cholecystitis (83.58%) followed by chronic acalculus cholecystitis (7.11%). Remaining cases were of Acute on chronic cholecystitis (3.20%), Eosinophilic cholecystitis (0.16%), Cholesterosis (4.22%), Xanthogranulomatous cholecystitis (0.21%), Follicular cholecystitis (0.16%), Polyp (0.05%), Metaplasia (0.26%), Adenomyoma (0.64%) and Adenocarcinoma (0.37%).Conclusion:The incidence of chronic calculus cholecystitis was found to be 83.58 % with female preponderance and mostly in third decade. Malignancy of gall bladder is a rare condition. Routine histopathological examination of all cholecystectomy specimens is strongly recommended for the detection of various variants of chronic cholecystitis and also of incidental carcinoma of gall bladder which helps in their treatment and prognosis. [ABSTRACT FROM AUTHOR]

Background: Gall bladder presents variable morphology, the knowledge of which is essential for various diagnostic and surgical procedures involving gall bladder. Aim and Objectives: To study the morphological variations of gall bladder in embalmed human cadavers. Material and Methods: The study included livers extracted from forty (40) embalmed human cadavers dissected for undergraduate MBBS classes in a medical college in Eastern India during the period August 2013 to May 2019. The dimensions of gall bladder was measured with a metal scale and variations in their shape and external features were noted. Results: The mean length and breadth of gall bladder was found to be 7.54 ± 1.62 cm (3.6-12.2 cm) and 3.44 ± 0.76 cm (1.8-6 cm) respectively. The various shapes of gall bladder were pear shaped (80 %), flask shaped (5%), cylindrical (5%), irregular (5%) and quadrate (2.5%). The external variations of gall bladder were as followsatrophic gall bladder (2.5%), deeply placed gall bladder (2.5%), absent gall bladder (2.5%), folding of neck of gall bladder (5%), phrygian cap (5%) and Hartmann's pouch (2.5%). Conclusion: The study will be of use for surgeons performing laparoscopic cholecystectomy in minimising hepato-biliary injuries. [ABSTRACT FROM AUTHOR]

Objectives: Both approaches are compared for their pros and cons regarding post-operative pain at site of removal. Study Design: Randomized control study. Setting: Department of surgery of Allama Iqbal medical college/ Jinnah hospital Lahore. Period: August 2017 to February 2018. Material & Methods: To compare mean post-operative pain in gall bladder retrieval through umbilical versus xiphoid port in four ports laparoscopic cholecystectomy for acute cholecystitis. Patient were divided in two equal groups with first group had their gall bladder retrieved through umbilical port while the other underwent retrieval through xiphoid port. Standard analgesia was used in both groups and post-operative outcome was noted. Results: A total 70 patient with equal distribution in two groups were enrolled to compare postoperative pain at port site comparing umbilical versus xiphoid process. Mean post-operative pain visual analogue scale (VAS) was as lower (p<0.0001) at 1, 6, 12 & 24 hrs. In umbilical port group as compared to xiphoid port group. Conclusion: Mean post-operative pain in gall bladder retrieval umbilical port give advantage in post-operative period regarding significantly reduced pain when compared with xiphoid port in four ports laparoscopic cholecystectomy for acute cholecystitis in selective cases. [ABSTRACT FROM AUTHOR]

• Low-monoenergetic images were preferred for the detection of gallbladder mucosal integrity. • Higher Likert scores for liver enhancement and gallbladder mucosa on low- Kev images associated with positive bile cultures. • Low-Kev liver enhancement and gallbladder mucosal discontinuation were better predictors of superimposed infection. • The strongest predictor variable for bile culture positivity was pericholecystic liver enhancement score. Low mono-energetic CT has been shown to improve visualization of acute abdominal inflammatory processes. We aimed to determine its utility in patients with acute cholecystitis and potential added value in clinical decision making. Sixty-seven consecutive patients with radiological signs of cholecystitis on contrast-enhanced dual-layer CT imaging were retrospectively identified over a four-year period (2/17–8/21). A ranked Likert scale was created for imaging findings present in acute cholecystitis, including gallbladder mucosal integrity and enhancement and pericholecystic liver parenchymal enhancement. These rankings were correlated with laboratory data, followed by sensitivity, specificity, and odds-ratios calculations. Mucosal integrity and pericholecystic liver enhancement were better seen on low-energetic images by unanimous consensus. Presence of pericholecystic liver enhancement and poorer mucosal wall integrity correlated with positive bile cultures (sensitivity: 93.8 % and 96.9 %, specificity: 37.5 and 50.0 %; odds-ratio: 9.0[1.1–68.1 95 %CI] and 31.0 [2.7–350.7 95 %CI], p = 0.017 and p ≤ 0.001) in patients undergoing cholecystostomy (n = 40/67). Moreover, binary regression modeling showed that the strongest predictor variable for bile culture positivity was the score for pericholecystic liver enhancement (Exp(B) = 0.6, P = 0.022). By contrast, other laboratory markers and other imaging findings (such as GB wall thickness) showed lower sensitivities (76–82 %), specificities (16–21 %) and odds ratios (0.2–4.4) for the prediction of infected bile. Pericholecystic liver enhancement and gallbladder wall integrity are better visualized on low-DECT images. These findings also potentially predict bile culture positivity in patients with cholecystitis, which may influence clinical management including the need for intervention. [ABSTRACT FROM AUTHOR]

Cholelithiasis is the presence of one or more gallstones within the gallbladder. Gallstone disease is a common cause for surgical intervention all over the world.The objective of the study is to determine the order of frequency of clinical presentations for cholelithiasis in laparoscopically cholecystectomized patients in ALKarama teaching hospital.A total sample of 156 clearly documented gallstone disease and laparoscopic cholecystectomized patients were involved in the present study. In the current study, 156 laparoscopic cholecystectomized patients; (34) males and (122) females, ages range between 20 and 69 years with a mean (m=39.24±11.7). Common factors that justified the indication for laparoscopic cholecystectomy (LC) were found in the majority of patients with asymptomatic and mild GI presentation those factors include microlithiasis < 3mm, risk for gallbladder CA, history of bariatric surgery, coexistent morbidities like diabetes mellitus (DM) and hemolytic anemia (HA) or the LC was done in concomitant with another laparoscopic surgery.From the present study, we concluded that the mild GI symptoms represented by dyspepsia, nausea, flatulence and constipation, were at the top of clinical presentations for gallstone patients who underwent LC. The distribution of cases was higher in the 4th decade of life with female predominance. [ABSTRACT FROM AUTHOR]

Objective:Cholecystitis is a generally widespread problem in adult population. Multiple findingshave been found in gross and microscopic examination of gallbladder. Existence of stones is one of the known causative factors that lead to histopathological changes in gallbladder. It is also responsible for the development of gallbladder carcinoma. The purpose of this study was to find out the histopathology of gall bladder specimens following surgical intervention. Study design: Observational study Place and duration of study: This study was conducted at Surgery Department of Abbasi Shaheed Hospital and Pathology Department of Ziauddin Hospital, from January 2017 to February 2020. Material and Methods: This observational study included 2,320 patients with acute orchroniccholecystitis secondary to gallstones that were admitt ed through the outpatient Department. Non-probability convenient sampling technique was used. Writt en and informed consent was taken from all the participants. Data was analyzed using SPSS version 20. Descriptive analysis was performed. Results: A total of 2,320 gallbladder specimens that presented for histo-pathological examination during the study period were included into the study, with male to female ratio of 1:3. The highest prevalence was found in the age group of 31-50 years. The results of histopathological examination of these gallbladder specimens showed that chronic cholecystitis was found in 1353 (58.3%), acute cholecystitis in 469 (20.2%), Gangrenous cholelithiasis 33 (1.4%) and cholestrolosis in 333 (14.3%) patients. Dysplasia was found in 8 (0.34%) patients, and gall bladder carcinoma was detected in 16 (0.69%) patients. There were 2181(94%)cases of calcular-cholecystitis. On morphological analysis, the commonest gall stones were made up of cholesterol and the most common lesion was chronic cholecystitis by histopathology. Conclusion: This study concludes that the chronic calcular-cholecystitis was dominant in our population. It is assumed that routine histopathological examination following cholecystectomies essential for all gallbladder specimens even in the non-existence of macroscopic signs of carcinoma, which was the case in our patients. [ABSTRACT FROM AUTHOR]

Thyroid tissue in an ectopic location (choristoma) seen in the gall bladder is a rare entity. We report a case of thyroid tissue in an ectopic location in gall bladder in a 29 year old woman with recurrent abdominal pain. Abdominal ultrasonography showed multiple gall stones and after cholecystectomy, the histopathology showed thyroid tissue in an ectopic location seen in the wall of the gall bladder. [ABSTRACT FROM AUTHOR]

A English cocker spaniel was presented with hematuria, lethargy and passing grey coloured pasty stools. Physical examination revealed normal vitals, icteric mucous membranes, no pain or organomegaly on palpation. Blood picture revealed anemia and elevated liver values. Ultrasonographic examination showed hypo-echogenicity of liver, distended gall bladder with anechoic content and two hyperechoic intensities of acoustic shadowing. Severe bile peritonitis due to perforation of the bile duct was observed on exploratory laparotomy. Liver showed cirrhotic and nodular changes whereas the kidneys were shrunken and fibrotic. Histopathological studies revealed cystic hyperplasia of the biliary epithelia, periportal fibrosis and chronic inflammatory changes in liver. Kidney sections revealed glomerular atrophy and fibrotic changes. [ABSTRACT FROM AUTHOR]