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Primary hepatic tuberculosis is a rare presentation and sporadically reported in the literature, mostly from our part of the world. Sometimes the presentation can be atypical and mimics hepatic tumor and poses diagnostic challenge. We, herein, present a case of a 58-year-old man who presented to us with abdominal pain and weight loss. Raised serum alkaline phosphatase (ALP) and imaging raised a suspicion of gall bladder carcinoma with hepatic invasion. Peroperative frozen section revealed hepatic chronic granulomatous inflammation with caseous necrosis consistent with the diagnosis of hepatic tuberculosis. Surgery was postponed and he was put on antituberculous treatment. It is important to consider tuberculosis in the differential diagnosis of the space occupying lesion of liver in a patient with vague symptoms and abnormal findings on imaging. [ABSTRACT FROM AUTHOR]

In order to help veterinarians in application of surgical procedures in cat and detection of gall bladder disease so that, we gathered twenty-one domestic cats and concluded that three main forms were collected; single gall bladder, duplex fundus and bilobed gall bladder. Both the gall bladder forms and the hepatic ducts distribution were not related. The bile duct was constructed from the left and right hepatic ducts in addition to the cystic one. In some cases, we explored that a short common hepatic duct. Sonographically, the gall bladder appeared differ in conformance, encircled by echogenic wall and adjacent to the right medial lobe laterally and the quadrate lobe medially. [ABSTRACT FROM AUTHOR]

Background: Spontaneous gall bladder perforation is an uncommon event among neonates. The etiology of perforated gall bladder in this pediatric age group is idiopathic. Only 9 cases are available in literature up till 2019. Case Presentation: We are reporting a case of spontaneous gall bladder perforation in a 15-day-old neonate who presented with vomiting, abdominal distension, and jaundice. The gall bladder was perforated near the fundus. Per-operative cholangiogram showed the normal passage of contrast. Open cholecystectomy was performed. No postoperative biliary complications were observed. Conclusion: Though Gall bladder perforation of spontaneous nature is rare but should be kept in the differential diagnosis in neonates who present with jaundice, abdominal distension, and acute abdomen. [ABSTRACT FROM AUTHOR]

Membranous fat necrosis is a rare histological finding. Despite its low incidence and lack of clinical significance, it can involve various organs. Majority of membranous fat necrosis cases are diagnosed in breast lumps and skin in comparison to intra-abdominal lesions. There has been only one reported case of membranous fat necrosis of gall bladder in literature. A 56-year-old female patient with previous history of diabetes mellitus and hypertension was administered due to abdominal pain and fever. Based on her physical exam, lab data, and ultrasonography, she was diagnosed by cholangitis. After primary care, she went under cholecystectomy. The histological finding of gall bladder revealed crenulated fatty membranes phagocytized by macrophages in Hematoxylin and Eosin (H&E) staining. Moreover, necrosis and giant cells were seen on Sudan black staining. Hence, the diagnosis of membranous fat necrosis in gall bladder was made. Membranous fat necrosis occurs when peripheral blood circulation is compromised. Ischemia of fat tissue cause fatty membranous material accumulation acting as foreign bodies. Hence, it can attract inflammatory response. Regarding pathology, phagocyted membranous by macrophages and giant cells is diagnostic. Sudan black, Luxol fast blue (LFB), long Ziehl-Neelsen, and D-PAS are positive in membranous fat necrosis. Membranous fat necrosis of gall bladder is a rare entity. This is the second reported case of such diagnosis. Nonetheless, further pathological investigations are necessary. • Membranous fat necrosis, gall bladder, acute cholangitis [ABSTRACT FROM AUTHOR]

Purpose Acute care surgery (ACS) models have evolved worldwide over the last decade. However, South Korea has an established trauma system and does not consider the ACS model. This study compares the management and outcome of emergency cholecystectomy in the ACS model to those of traditional on-call attending surgeon model for emergency surgery. Methods Retrospectively collected data for patients who underwent emergency cholecystectomy from May 2013 to January 2015 was analyzed to compare data from a traditional on-call system (OCS) and ACS. Results One hundred and twenty-four patients were enrolled in the study (62 patients ACS vs. 62 patients OCS). Hospital stay (days) (ACS=4.29±2.49 vs. OCS=4.82±4.48, p=0.46) and stay in emergency room (minutes) (ACS=213.10±113.99 vs. OCS=241.10±150.73, p=0.20) did not differ significantly between groups. Operation time (minutes) was significantly shorter in the ACS than OCS group (389.97±215.21 vs. 566.35±290.14, p

This study aims were to describe lesions and their intensities of histopathological changes in gallbladder mucosa of bali cattle that infected with Fasciola gigantica. As many as 42 gall bladers of balicattle were used in this studi, i.e: 35 samples were infected and sefen were non-infected with F.gigantica.The samples were randomly gathered from Pesanggaran slaughter house in Denpasar. The gall bladderswere evaluated macroscopically and prepared for microscopically examination using haematoxylin andeosin staining.The result showed that there were histopathological changes observed in the mucosa of thegall bladder:necrosis cells of gall bladder with intencity 100%, hemorrhage 68.5%, hyperplasia serousgland and mucous hypertrophy gland 100%, collagen in filtration 100%, fibroblast proliferation 91.4%,and infiltration of inflammation cells, 74.2%. Histopathological changes in gallbladders mucous of balicattle infected F.gigantica experiencing severe lesons with frequency percentage above 50%.

Gall bladder perforation (GBP) is a rare life threatening complication of acute cholecystitis, which has high morbidity and mortality. Aim of the study: The aim of the study was to evaluate the role of multislice CT (MSCT) in the diagnosis of GBP and detection of its complications. Patients and method: Study included retrospective evaluation of 23 patients with GBP. All the patients were evaluated with abdominal ultrasonography and contrast-enhanced abdominal MSCT. Results: Twenty-three patients were reviewed over a period of 18 months: 7 patients with type I GBP, 16 patients with type II and no patients with type III GBP. Abdominal US showed gall stones, wall thickening, free intra-peritoneal fluid and pericholecystic fluid collection. GB wall defect could not be detected in US for all patients. Reviewing the MSCT, the most important point was the detection of wall defect, either single or multiple and its site: fundus (19 patients) or body (4 patients). 3 patients were associated with sub-hepatic abscess. Conclusion: MSCT was found to be a sensitive modality for the detection of GBP and its complication and we recommended MSCT for all cases suspected to have GBP.

Introduction: Liver is largest gland in the body and shows rare variation. Additional fissure, additional lobes, enlarged papillary process, variations of gall bladder are more common. Morphological variations have been classified into congenital or acquired. Aim: To evaluate embryological rational of rare variations of liver and find out their impact on diagnostic and clinical procedures. Materials and Methods: We studied 20 formalin fixed liver specimens in Anatomy Department during undergraduate teaching to find out variant gross morphological features of liver. Results: Some rare variations were observed like grooves on hepatic surface (10%), tunnel for ligamentum teres (15%), enlarged papillary process (10%), absence of quadrate lobe (5%), additional fissures (20%), lingular process (15%). Conclusion: Atrophy, agenesis, presence of accessory lobes, additional fissures may mislead the diagnostic procedures. Therefore, the knowledge of these variations may be a fruitful finding for diagnosticians as well as surgeons.

Introduction: Laparoscopic Cholecystectomy (LC) has numerous benefits over the open method; still postoperative pain remains an issue. Postoperative pain, requiring injectable analgesics prolong the patient’s hospital stay, and is one of the hurdles in performing LC as a day-case surgery. Aim: To assess the analgesic effect of Intraperitoneal (IP) administration of Inj. Bupivacaine±Inj. Tramadol in patients undergoing LC. Materials and Methods: A total of 100 patients scheduled for LC were enrolled in the study after meeting the inclusion criteria. Patients were randomly divided into 3 groups. Patient allocated to Group A received 30 mL of inj. normal saline IP, Group B received 30 mL of 0.25% inj. bupivacaine and Group C received 30 mL of 0.25% inj. bupivacaine along with 100 mg inj. tramadol. The local anaesthetic/analgesic or placebo solution was sprayed on the upper surface of the liver and on right subdiaphragmatic space and over gall bladder bed. The pain intensity of pain for patients in all the three groups were recorded using VAS at 0, 1, 2, 6, 12 and 24 hours after surgery. The student t-test was used to compare mean pain score between groups. The p-value ≤0.05 was taken as significant. Results: There was statistically significant difference in postoperative pain intensity in group A vs groups B (p

Introduction: Cholelithiasis means the “presence of stone in the gall bladder” is a common clinical entity affecting the adult population of both sexes. Various sign and symptoms like severe pain in Murphy’s point in right upper quadrant of abdomen, bilious vomiting, mild to moderate increase in temperature, obstructive jaundice, loss of appetite and weight are present in cholelithiasis. Gallstones are known to produce diverse histopathological changes in the gall bladder. Aims: The study was undertaken to assess prospectively the influence of physical, clinical and biochemical characteristics on type of gallstones and their relationship in patients of cholelithiasis. Materials and Methods: The study was done in hundred patients of cholelithiasis of both sexes, aged between 12 years to 80 years who underwent cholecystectomy. The stones were assessed for various parameters i.e. number, size, morphological types and correlated with clinical Indices of cases (Haemoglobin, TLC, DLC, Blood sugar, SGOT, SGPT, Alkaline phosphatase, total serum bilirubin, direct serum bilirubin, Indirect serum bilirubin , total serum protein and albumin values) and also with diabetes mellitus ,smoking, tobacco chewing, alcohol intake and dietary habits of cases of cholelithiasis. Results: Out of total 100 specimens examined in present study, 24 had cholesterol (male-4, female-20), 46 had mixed (male-11, female-35) and 30 had pigmented (male11, female-19) gallstones respectively. Number of stones varies from a single calculus in 30% cases, double in 12% cases and multiple in remaining 58% of cases. Shape of stone varied from polygonal/rectangular in 1% cases, ovoid in 15%, rounded in 22%, irregular in 29% and maximum had faceted shaped gallstone in 32% of cases. Haemoglobin, TLC, DLC, Blood sugar, SGOT, SGPT, Alkaline phosphatase, total serum bilirubin, direct serum bilirubin, Indirect serum bilirubin, total serum protein and albumin values did not showed statistically significant correlation with gallstone types. The mean systolic BP (p

In article you can find information about structure of biliary tract, pathogenesis, classification and clinical picture of biliary sludge. We pay special attention on algorithms of diagnosis of biliary tract dysfunction and proper way of doctor according to results of laboratory and instrumental investigations. We provide recommendations of using such medication as Ermytal in treatment of patients with biliary tract dysfunction.

Objective Our goal is to describe and report the outcomes of patients undergoing robotic single-site cholecystectomy at a single institution. Background Cholecystectomy is a common procedure performed to remove the gallbladder. Robotic single-site cholecystectomy (RSSC) is rapidly emerging as a safe and feasible alternative to conventional 4-port laparoscopic techniques. Patients who undergo RSSC procedures may also have a decreased need for postoperative analgesics and a lower postoperative pain score. Methods From September 2020 to August 2023, there were 33 cases of RSSC performed by a single surgeon at a single institution. We recorded demographic data including sex, age, and BMI as well as postoperative outcome data including wound dehiscence, postoperative infection, biliary leakage, wound herniation, blood loss, and conversion to open procedure. Results The patient group included 24 females (72.7%) and nine males (27.3%) with a median age of 32 (Range: 9-70) and a median BMI of 24.2 kg/m 2 (Range: 18.1-30.7). The majority of these patients were receiving cholecystectomies for benign conditions such as symptomatic cholelithiasis (n = 18, 54.5%), biliary dyskinesia (n = 13, 39.4%), acute cholecystitis (n = 1, 0.03%), and biliary colic (n = 1, 0.03%). The average estimated blood loss was 5.91 mL. Thirty-two patients (96.9%) were discharged home the same day of surgery. One patient was admitted overnight for observation due to severe biliary dyskinesia diagnosed preoperatively. The patient had no complications and was discharged the following day. One patient presented with acute abdominal wall cellulitis and omphalitis with no underlying abscess four weeks after the operation. They were treated with therapeutic antibiotics. No patients underwent conversion to an open procedure. There were no incidences of postoperative wound dehiscence or biliary leakages. One patient was admitted overnight for observation of biliary dyskinesia and another experienced abdominal wall cellulitis four weeks post-operation. Conclusions Although conventional multi-incision laparoscopic cholecystectomy remains the gold standard treatment for benign gallbladder disease, our study demonstrates the practicality and safety of Robotic Single-Site Cholecystectomy procedures., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Salim et al.)

Introduction: Laparoscopic Cholecystectomy (LC) has numerous benefits over the open method; still postoperative pain remains an issue. Postoperative pain, requiring injectable analgesics prolong the patient's hospital stay, and is one of the hurdles in performing LC as a day-case surgery. Aim: To assess the analgesic effect of Intraperitoneal (IP) administration of Inj. Bupivacaine± Inj. Tramadol in patients undergoing LC. Materials and Methods: A total of 100 patients scheduled for LC were enrolled in the study after meeting the inclusion criteria. Patients were randomly divided into 3 groups. Patient allocated to Group A received 30 mL of inj. normal saline IP, Group B received 30 mL of 0.25% inj. bupivacaine and Group C received 30 mL of 0.25% inj. bupivacaine along with 100 mg inj. tramadol. The local anaesthetic/analgesic or placebo solution was sprayed on the upper surface of the liver and on right subdiaphragmatic space and over gall bladder bed. The pain intensity of pain for patients in all the three groups were recorded using VAS at 0, 1, 2, 6, 12 and 24 hours after surgery. The student t-test was used to compare mean pain score between groups. The p-value ≤0.05 was taken as significant. results: There was statistically significant difference in postoperative pain intensity in group A vs groups B (p <0.0001) and also between group A vs group C (p <0.0001) during the first 6 hours postoperatively. But the difference in VAS scores between groups B and C were not statistically significant at all times of postoperative recordings. The addition of inj. tramadol to inj. bupivacaine (group C) IP did not cause a significant reduction in pain compared to bupivacaine only group(group B) but there was increased incidence of Post Operative Nausea and Vomiting (PONV) noted in group C as compared to group B. conclusion: IP inj. bupivacaine may be used routinely in LC as a part of day-case surgery leading to adequate postoperative pain relief, decreasing need for analgesia and opioids which may lead to early ambulation and initiation of oral feeds, leading to faster postoperative recovery and hence shorter hospital stay, thereby decreasing the burden both to the patient as well as to the hospital. [ABSTRACT FROM AUTHOR]

The objective in the present study was to reconnoiter the morphological structure and biometrical parameters of embryonic gallbladder and cystic duct during the fetal life of Gaddi sheep. A Total number of 40 Gaddi sheep foetii samples were collected irrespective of sex and without any external anomaly or pathology. The age estimation of each foetus was done and accordingly the foetii were grouped as; group-I (1-60days), group-II (61-90days) group-III (91-120days) and group-IV (121 -full term). The gall bladder from each foetii were excised hygienically. Gall bladder appeared at Crown Rump Length CRL 6.0 cm (46 days of gestationl age) and was slate blue colour in fresh state and settled into the visceral surface of right lobe of liver. It had single opening which continued as cystic duct. The maximum length and width of gall bladder (1.85 cm and 0.75 cm respectively) and cystic duct (1.68 cm and 0.18 cm respectively) increased with the advancement of gestational age. [ABSTRACT FROM AUTHOR]

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Acute cholecystitis is responsible for 44 % of emergency admissions to the emergency services with multiple complications such as empyema a necesitatis (EN). EN has a close relation with cholecystitis when the perforation of the gallbladder (GB) can lead to the formation of a biliary fistula. Patients can be asymptomatic, with late consultations, thus being a diagnostic challenge. Different techniques are described for cholecystitis and secondary abscess, therefore, the choice of the appropriate procedure should be the best one to reduce the high associated morbidity. We present a case of an 89-year-old patient, admitted for a sensation of a mass in the right hypochondrium with abdominal pain. He was taken to the operating room, finding a vesicular plastron with piocholecyst and perforation into the abdominal wall with abscess and fasciitis. Subtotal cholecystectomy was performed laparoscopically and an open approach in the abdominal wall, drainage of the abscess and debridement, leaving a negative pressure system. EN affects elder patients with high rates of morbidity, also GB empyema, which is related with its perforation and posterior fistulization, its external spontaneous perforation is much less frequent. Fistulas originated from the biliary tract are well described in the literature, with low incidence. They are related with improved diagnostic investigations and earlier implemented treatment by antibiotics and surgery. Biliary EN represents a very unusual complication of acute cholecystitis, its atypical presentation represents a diagnostic challenge, with very few cases documented and high mortality rates. Its management represents a challenge for the general surgeon, finding different approaches and surgical behaviors to take. • There are multiple complications associated with this entity, one of them, is empyema a necesitatis. • Perforation is a complication of cholecystitis, it can be generated by carcinoma or spontaneous and can lead to fistulization. • The management on the acute phase, consists of analgesics, antibiotics and common treatment for acute cholecystitis. • There are several surgical options such as cholecystectomy, cholecystostomy or abdominal drainage. [ABSTRACT FROM AUTHOR]

Heterotopic pancreatic tissue in the gall bladder is an uncommon incidental finding in most cases. We hereby describe the case of a 45-year-old woman who presented with symptoms of acalculous cholecystitis. Pathological examination detected heterotopic pancreatic tissue, pseudopyloric metaplasia, and adenomyomatous hyperplasia in the gall bladder. This is a rare combination of three entities which is being reported for the first time. This case emphasizes that heterotopic pancreas might be the causative factor for cholecystitis.

In this work, we undertook a study of the sonographic parameters of the pancreas and gall bladder in healthy men with different somatotypes. The study-subjects were from the Podillya region of Ukraine. Herein, the majority of gallbladder dimensions (length, thickness, cross-sectional area and volume) in men type-classified as endo-mesomorphic, were significantly higher when compared with men in general and with those of the meso- and ecto-mesomorphic somatotype. Furthermore, the dimensions of the pancreas (width of head and tail length) in mesomorphic males were significantly higher than that of endo-mesomorphic males. The rest of the studied parameters (length, longitudinal cross section area of the gall bladder, the thickness of the head, body and head length, the width of the body and tail of the pancreas) in men of the different somatotypes have no significant differences.