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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]

The author outlines his philosophy and practice of management of gall bladder cancer based on his more than three-decade experience at a large tertiary level super-specialty referral hospital attached to a university-status teaching institution at Lucknow in northern India where GBC is very common. [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]

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]

Xanthogranulomatous cholecystitis (XGC) presents a diagnostic challenge due to its rarity and varied clinical manifestations and nonspecific radiological findings. We here describe a 67-year-old man with right hypochondriac pain, where imaging revealed irregular thickening of the gallbladder wall, prompting consideration of various differential diagnoses including gallbladder malignancy, adenomyomatosis, and complicated cholecystitis. With inconclusive lab results, cholecystectomy with potential extended hepatectomy was advised. Intraoperatively, an inflamed gallbladder was observed. Histopathological examination confirmed XGC, stressing histological verification. Complete cholecystectomy is standard, with partial resection an option. Our case details the complexity in diagnosis and management of XGC.

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]

BackgroundLiposarcoma (LPS) is a kind of malignancy of soft tissue usually found in the retroperitoneal, limb, or neck region, and some may be detected with delayed symptoms (pain or palpable mass), and less frequently occurs in organs of the digestive system. In contrast, Dedifferentiated liposarcoma (DDLPS) is a common histological subtype of LPS. The present study reported a case of dedifferentiated liposarcoma originating in the gallbladder. Differentiated liposarcoma originating from the gallbladder is rarely reported.Case descriptionA 64-year-old female patient presented to our hospital with a painless abdominal mass. Abdominal computed tomography (CT) showed that the gallbladder had lost its normal shape, and a 9.1 cm × 7.1 cm × 12.1 cm mass was seen in the area of the gallbladder fossa and the right upper abdomen below it, which had an irregular morphology, inhomogeneous density, and nodular calcification, with marked inhomogeneous enhancement on enhancement scan. Preoperative tumor markers and liver function indicators were not abnormal. With suspicion of a giant malignant tumor of the gallbladder, she underwent a cholecystectomy combined with abdominal mass resection. After surgery, the tumor and gallbladder, were completely resected, and postoperative pathological results confirmed the diagnosis of dedifferentiated liposarcoma deriving from gallbladder. After surgery, the patient and his family refused to continue treatment. After 15 months follow-up, the patient remains asymptomatic and does not show any signs of recurrence. And she is now under continued follow - up.ConclusionsTreatment of dedifferentiated liposarcoma is still at exploratory stage, and a lack of clinical evidence for this condition might hinder access to clinical trials and studies. Currently, the treatment of choice for dedifferentiated liposarcoma remains radical resection. In the available clinical studies, there are no robust data to support clinical use of neoadjuvant and adjuvant radiochemotherapy. As with other diseases, the use of radiotherapy and chemotherapy before and after surgery may be a potential future treatment.

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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]

Background: Choledochoduodenal fistula is a rare and poorly understood condition that results from the anomalous formation of a communicating tract between the common bile duct and the duodenum. While the precise etiology is not understood there has been a notable increase in identified cases in the last 20 years. The symptoms of choledochoduodenal fistula are vague and it is often not diagnosed until the patient develops cholangitis. Case report: A 70yo M with a recent diagnosis of hepatitis C presented to the emergency department for evaluation of jaundice. Ultrasound demonstrated a hydropic gallbladder with “double duct” sign. The patient was admitted to the hospital and underwent ERCP. This identified a choledochoduodenal fistula which was treated. On follow up the patient had marked improvement with no significant sequelae or complications. Why should an emergency physician be aware of this?: Choledochoduodenal fistula is a rare and poorly understood pathology. However, choledochoduodenal fistula “attacks” are strongly associated with cholangitis which has a mortality approaching 5 ​% even when appropriately managed (Sokal et al., Dec 2019) [1]. In our case, neither ultrasound nor portal vein-phased CT demonstrated the Choledochoduodenal fistula and ERCP was required both to identify and treat the fistula. In the setting of obstructive jaundice, it may be prudent for the emergency physician to consider transfer to a center with ERCP capability if it is not readily available in their facility.

Key Clinical Message Cystic artery pseudoaneurysm is a rare phenomenon associated with cholecystitis. We describe the successful management of angioembolisation and cholecystectomy. Abstract 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.

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]

The study focused on anthropometric measurements and their relationship with the hormone cholecystokinin (CCK) and its role in the incidence of gallstones for both sexes. The samples of the study included 97 ones which were collected from patients with gallstones and 83 samples as a control group. The results showed that the decrease in the hormone level compared to an increase in glucose, uric acid, bilirubin, creatinine, urea, and body mass index (BMI) for a group of people with gallstones compared with the control group, and that the infection rate in women is higher than in males. Also, Age is a major factor that affects hormone levels and reduces activity cholecystokinin hormone. Women of fertile age are usually more susceptible to gallstones due to increased obesity around the abdominal area and pregnancy. The incidence rate is almost equal with advancing age after the age of fifty due to menopause in women. Finally, this study discovered a relationship between the decrease of the cholecystokinin hormone and the increase of the risk factor of formation of gallstones, which have a strong role, especially in people who are obese with age. [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]

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]

BACKGROUND: Current descriptions of the history of subtotal cholecystectomy require more details and accuracy. The first cholecystectomy was performed by Carl Langenbuch in the Lazarus hospital of Berlin on 15 July 1882. AIMS AND OBJECTIVE: To Study the outcome of Laparoscopic Subtotal cholecystectomy without Cystic Duct Ligation (Open tract or fenestrative) for difficult Cholecystitis. METHODS AND MATERIALS: A Prospective observational study was conducted in the department of General surgery, IQ City Medical College and Hospital, Durgapur with patients of 25 to 60 years of age, posted for laparoscopic cholecystectomy between January 2015 to December 2022, with per-operative finding of difficult anatomy, where critical view of safety was not achieved after 30 minutes of laparoscopic procedure. RESULT In our study, 36 (21.05%) patients with bile leak, 9 (5.26%) were prolonged beyond 2 weeks, out of which further 4 settled down soon on their own, but rest 5 with deranged LFT not. So, ERCP and CBD stenting was arranged for them, which settled down the bile leak in them. CONCLU SION: Opened tract or fenestrative laparoscopic subtotal cholecystectomy (LSTC without is a relatively cystic duct ligation) straightforward, easy, safe and effective alternative to open conversion when dissection of Calot's triangle is hazardous. [ABSTRACT FROM AUTHOR]

The World Federation of Ultrasound in Medicine and Biology (WFUMB) has started a series of position papers highlighting the role of ultrasound techniques for diagnosis, risk assessment and follow-up of incidental imaging findings. Gallbladder and biliary tree are among the most frequent anatomical localizations of incidental findings. A first part of the position paper on incidental findings of gallbladder and bile ducts was related to gallbladder polyps and other incidental findings of the gallbladder wall. Based on a description of normal findings, this second part addresses congenital anomalies and variations of the gallbladder and the biliary tree, asymptomatic bile duct dilatation and “silent” gallstones. Based on evidence on prevalence and outcome and with a special focus on ultrasound techniques, the position paper makes recommendations regarding diagnostic work-up, follow-up and treatment of these incidental findings.

Gallbladder neuroendocrine carcinoma is a rare neoplasm thought to arise in the background of chronic inflammation triggered by cholelithiasis. The symptoms of this tumor overlap with those of cholecystitis and other carcinomas of the gall bladder. The imaging findings with fine needle aspiration cytology help in the pre-operative diagnosis. However, the gold standard for diagnosis is histopathology evaluation with immunohistochemistry. We report a case of a 76-year female who was clinically diagnosed with acute calculus cholelithiasis and underwent surgery. The histopathology and immunohistochemistry of the gallbladder revealed neuroendocrine carcinoma.

Avian Dicrocoeliidae are difficult to identify, even in their adult stages. Molecular analyses have been conducted for only a few species, complicating the accurate identification of juvenile stages. The taxonomy of the family is unresolved, and the status of many dicrocoeliid species is uncertain. Sequences of nuclear and mitochondrial DNA loci of Central European avian Dicrocoeliidae were generated and analyzed. These included representatives of the genera Lyperosomum, Platynosomum, Stromitrema, Brachylecithum, Brachydistomum, and Lutztrema. All the sequences were obtained from morphologically identified adult specimens of dicrocoeliids isolated from avian hosts. Molecular support was obtained to validate Lyperosomum turdia, confirm the rejection of Lyperosomum dujardini and Lyperosomum alagesi, and resurrect Lyperosomum longicauda and Lyperosomum collurionis. The identity of European Platynosomum illiciens from avian hosts with American vouchers of the same species from avian and mammalian hosts was confirmed. Brachylecithum fringillae is not considered valid; the individuals that matched its diagnosis were subadult Brachydistomum ventricosum. Descriptions and comparative data for five new species are provided. These are Lyperosomum hirundinis sp. n., Lyperosomum tenori sp. n., Lyperosomum atricapillae sp. n., Stromitrema acrocephali sp. n., and Lutztrema atricapillae sp. n.. Based on the molecular data, suggestions are provided regarding the validity of dicrocoeliid species that parasitize Central European birds. Further research should address the polyphyletic status of Brachylecithum.

Abstract Background Cystic lymphangiomas are benign vascular malformations of lymphatic differentiation. They usually occur in childhood and are commonly seen in the head and neck region. Lymphangioma of the gallbladder is extremely rare, and only a handful of cases have been reported in the literature. Case presentation A 56-year-old female presented to the outpatient department for evaluation of right upper quadrant abdominal pain which had been bothering her for the past few months. Abdominal ultrasonography revealed an ill-defined septated cystic lesion surrounding the gallbladder (GB) which was initially thought to be a collection. However, contrast-enhanced computed tomography of abdomen showed a well-marginated fluid density lesion in the gall bladder fossa which was insinuating around the gall bladder and was encasing it. No intralesional enhancement was seen after contrast administration. MRI confirmed the well-defined, multiseptated lesion without any solid component in the gall bladder fossa encasing the GB but without any abnormal communication with the biliary tree. Therefore, a final diagnosis of slow flow lymphatic malformation was formulated. The patient underwent exploratory laparotomy, and the mass was resected en bloc with the GB. Histological evaluation was consistent with lymphatic malformation. Conclusions GB lymphangioma is a rare entity and is difficult to diagnose. While the imaging characteristics are essentially similar to lymphangiomas elsewhere in the body, the location is peculiar and should warrant a thorough evaluation by the means of CT and more importantly MRI.

Background and objective: In western countries, the incidence of Cholelithiasis is found to be more than 10% in general populations. After performing the first successful laparoscopic cholecystectomy (L.C.) in Germany by Muhe in 1986, it rapidly became the procedure of choice in treating symptomatic gall stone. L.C. has a lot of advantages, including minimal trauma, rapid recovery, less analgesic requirement with a good esthetic outcome, however even in the hands of a best surgeon still there is a small percentage of conversion to open laparotomy, some risk factors has been recognized as a reason for the conversion to open laparotomy. This study aims to evaluate the rate with the underlying risk factors that increase the chance of conversion to open cholecystectomy. Methods: A total of 1400 patients for whom L.C. was attempted, 54 were enrolled in this prospective study from January 2014 to January 2020. The exclusion criteria were malignancy or existence of gallbladder polyps detected pathologically. Patient demographics, indications for cholecystectomy, concomitant diseases, and histories of previous abdominal surgery were collected. The rates of conversion to open cholecystectomy with the underlying reasons for conversion were analyzed. Results: The overall rate of conversion to open cholecystectomy was 3.86% (54 patients). Out of 54 cases nearly two-thirds (61.1%) of the patients (33) were males and 38.9% of the patients (21) were females. Male: female ratio is 1.57:1. In the study sample, the conversion rate among obese (14/54) patients was 25.9% compared with the rate of 74.1% among non-obese (40/54) patients. Out of 3.86% of the conversion rate, 2.86% were non-obese and 1% were obese patients. The commonest etiology for conversion was thickened gall bladder due to severe gall bladder inflammation with fibrosis (21 patients) 38.9% followed by Acute cholecystitis (8 patients) 14.8%, then fibrosis (7 patients) 13% with aberrant anatomy at the calot’s triangle (6 patients) 11.1%. Conclusion: A thickened gall bladder was found to be the commonest risk factor for conversion to open cholecystectomy, the conversion from L.C. to O.C. should not be regarded as a failure of the procedure or as a complication, rather it should be regarded as a prudent maneuver for achieving the desired objective namely safe removal of the gall bladder.

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.

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]

Avian Dicrocoeliidae are difficult to identify, even in their adult stages. Molecular analyses have been conducted for only a few species, complicating the accurate identification of juvenile stages. The taxonomy of the family is unresolved, and the status of many dicrocoeliid species is uncertain. Sequences of nuclear and mitochondrial DNA loci of Central European avian Dicrocoeliidae were generated and analyzed. These included representatives of the genera Lyperosomum , Platynosomum , Stromitrema , Brachylecithum , Brachydistomum , and Lutztrema. All the sequences were obtained from morphologically identified adult specimens of dicrocoeliids isolated from avian hosts. Molecular support was obtained to validate Lyperosomum turdia , confirm the rejection of Lyperosomum dujardini and Lyperosomum alagesi , and resurrect Lyperosomum longicauda and Lyperosomum collurionis. The identity of European Platynosomum illiciens from avian hosts with American vouchers of the same species from avian and mammalian hosts was confirmed. Brachylecithum fringillae is not considered valid; the individuals that matched its diagnosis were subadult Brachydistomum ventricosum. Descriptions and comparative data for five new species are provided. These are Lyperosomum hirundinis sp. n., Lyperosomum tenori sp. n., Lyperosomum atricapillae sp. n., Stromitrema acrocephali sp. n., and Lutztrema atricapillae sp. n.. Based on the molecular data, suggestions are provided regarding the validity of dicrocoeliid species that parasitize Central European birds. Further research should address the polyphyletic status of Brachylecithum. [Display omitted] • Sequences of molecular markers to identify juvenile dicrocoeliids are provided. • Validity of dicrocoeliid species that parasitize Central European birds hosts was tested. • European Platynosomum illiciens from avian hosts is identical with American vouchers. • Five new species from the genera Lyperosomum , Stromitrema , and Lutztrema. [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]

Introduction: Gallstone is very common in our region due to high fat content in our diet. Mostly patient present in emergency department in acute presentation which was managed conservatively and planned for interval laparoscopic Cholecystectomy. Biliary leakage is dangerous complication which increase cost of treatment, morbidity and mortality. Methods: This study was conducted on 200 consecutive patients admitted in J.A. group of hospital and G.R. Medical College, Gwalior during the period of September 2018 to September 2021. Out of 05 patients developed significant biliary leakage. Result: The factors showing definitive association with increased post and intra operative complication in LC were thickened GB, contracted GB on USG while other finding peri cholecystic collection, impacted gallstones failed to show any significant association with biliary leakage. Conclusion: Identify the variables for difficult laparoscopic cholecystectomy and timely conversion to open cholecystectomy to decrease the morbidity & mortality to the patients and financial burden. [ABSTRACT FROM AUTHOR]

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Background: Cystic lymphangiomas are benign vascular malformations of lymphatic differentiation. They usually occur in childhood and are commonly seen in the head and neck region. Lymphangioma of the gallbladder is extremely rare, and only a handful of cases have been reported in the literature. Case presentation: A 56-year-old female presented to the outpatient department for evaluation of right upper quadrant abdominal pain which had been bothering her for the past few months. Abdominal ultrasonography revealed an ill-defined septated cystic lesion surrounding the gallbladder (GB) which was initially thought to be a collection. However, contrast-enhanced computed tomography of abdomen showed a well-marginated fluid density lesion in the gall bladder fossa which was insinuating around the gall bladder and was encasing it. No intralesional enhancement was seen after contrast administration. MRI confirmed the well-defined, multiseptated lesion without any solid component in the gall bladder fossa encasing the GB but without any abnormal communication with the biliary tree. Therefore, a final diagnosis of slow flow lymphatic malformation was formulated. The patient underwent exploratory laparotomy, and the mass was resected en bloc with the GB. Histological evaluation was consistent with lymphatic malformation. Conclusions: GB lymphangioma is a rare entity and is difficult to diagnose. While the imaging characteristics are essentially similar to lymphangiomas elsewhere in the body, the location is peculiar and should warrant a thorough evaluation by the means of CT and more importantly MRI. [ABSTRACT FROM AUTHOR]

Background: Cholelithiasis is one of the most common problems affecting the digestive tract. Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic cholelithiasis. This procedure though mostly safe and uneventful can be difficult at times. A lot of problems can be avoided by correct preoperative prediction of difficult cholecystectomy. Many studies have attempted to create a scoring system to predict difficulty in LC. One such scoring system was devised by Randhawa and Pujahari. Objective: The aim of our study was to ascertain the validity of this scoring system in our hospital scenario. Materials and methods: This was a prospective study conducted at District Hospital Anantnag, a rural healthcare center located in the valley of Kashmir, India, from September 2016 to September 2018. Out of 327 patients admitted for LC were enrolled. Each patient was assigned scores preoperatively based on the history, clinical assessment, and sonographic findings as described by Randhawa and Pujahari. All intraoperative events like duration of surgery, bile stone spillage, and injury to duct/artery were recorded. Postoperatively, we defined the surgical procedure as easy, difficult, and very difficult as described by Randhawa and Pujahari. Results: The mean age of patients in our study was 43 years. In our study, we observed that age >50 years, male sex, body mass index (BMI) >27.5, history of hospitalization for acute cholecystitis, palpable gallbladder on clinical examination, and thick wall gallbladder on sonography were statistically significant predictors of difficult LC. The sensitivity, specificity, positive predictive value and negative predictive value of this scoring system as reported by us are 86.41, 79.76, 92.51, and 67%. Conclusion: We conclude that the scoring system of Randhawa and Pujahari for the prediction of the difficulty of LC applies to rural settings and has high sensitivity, specificity, and accuracy. [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]

An undifferentiated carcinoma (UC) of the gall bladder behaves aggressively and has a grave prognosis. Small cell type undifferentiated carcinoma of the gall bladder is a rare variant. This paper reports a case of UC of gall bladder with PAS-positive diastase- resistant eosinophilic hyaline globules present as liver mass (on imaging) in a male patient. The microscopic findings of the liver and gall bladder after a right tri-segmentectomy showed an un-differentiated malignant neoplasm composed of cells with round to oval nuclei, prominent nucleoli, and scanty neoplasm. No definite cell pattern was identified with these neoplastic cells. A section from the gall bladder revealed a tumor arising from the lining epithelium and infiltrating through the muscularis. This tumor was infiltrating the adherent liver tissue directly and forming a mass of undifferentiated malignant cells. The focal area within the tumor mass showed the presence of PAS-positive, diastase-resistant, eosinophilic hyaline globules within the neoplastic cells. The immunohistochemistry test was diffusely positive for perinuclear anti-neutrophil cytoplasmic antibodies and negative for chromogranin, vimentin, Desmin, alpha-fetoprotein, leukocyte common antigen, CD34, and bcl2. When the clinical and radiological data are inconclusive, careful analysis of the histological and immunophenotypic features is needed to make the final diagnosis of UC of the gall bladder. The biological behavior and prognosis of this tumor remain unclear because of its rarity. Further studies will be needed to understand the characteristics of this deadly tumor and to establish an effective therapy for it.

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).

The epidemiology of parasite infection in local and imported breeds is quite an essential topic in the meat industry and human health. This study aims to determine the prevalence of Dicrocoelium dendriticum in local sheep breeds (Naemi, Najdi, and Harri) and imported breeds from Romania (Romani breed) and the epidemiology of the infection in Saudi Arabia. Morphological description, the relationship between dicrocoeliasis and sex, age, and histological changes were also presented. A total of 6845 slaughtered sheep at Riyadh Automated slaughterhouse were investigated and followed up for 4 months between 2020–2021. It included 4,680 local breeds and 2,165 imported Romanian breeds. Fecal samples and livers and gallbladders from slaughtered animals were examined for apparent pathological lesions. The results indicated that the infection rate in slaughtered animals was 10.6% in imported Romani sheep and 0.9% in the local Naeimi breed. After identifying the parasite morphologically, negative results were obtained from examining feces, gallbladders, and livers of Najdi and Harry sheep breeds. The mean number of eggs per 20 µL/gallbladder was low (72.78 ± 17.8: 76.11 ± 5.07), medium (334.59 ± 90.6: 292.91 ± 26.63), and high (1113.2 ± 22.3: 1004 ± 143.4) in imported and Naeime sheep, respectively. Significant differences were found between gender and age (males and females were 3.67% and 6.31%; > 2 years 4.39%, 1–2 years 4.22%, and 1 year 3.53%) respectively. Histopathological lesions in the liver were more pronounced. Our survey confirmed the presence of D. dendriticum in imported Romani and local Naeimi sheep, and the potential role of imported sheep in the epidemiology of dicrocoeliasis in Saudi Arabia.

Objective: To estimate the psychological and sociodemographic correlates of delayed discharge of patients undergoing Elective Laparoscopic Cholecystectomy. Study Design: Retrospective Cross-sectional Descriptive study. Setting: Department of Surgery, Fauji Foundation Hospital. Period: July 2019 and June 2022. Material & Methods: The study comprised reviewing medical records of 160 patients who underwent daycare cholecystectomy. It was noticed from patients’ medical records that patients were carefully selected for daycare surgery. Patients with comorbidities, previous upper intraabdominal surgery, ultrasound findings of thickened gallbladder wall > 5mm were not offered day care surgery. For data collection a Performa was designed based on literature review. To assess psychological state, we applied Hospital anxiety and depression scale in Urdu. Descriptive statistics were calculated for the sociodemographic variables, mean and standard deviation was found for continuous variables and frequency percentages for categorical variables. Results: One hundred and thirty-one 131 (81.8 percent) of the 160 cholecystectomies could be sent home within 24 hours, whereas 29 (18 percent) required a lengthier hospital stay. One hundred and thirty-one 131 (81.8 percent) of the 160 cholecystectomies could be sent home within 24 hours, whereas 29 (18 percent) required a lengthier hospital stay. In LS group, the postoperative stay range was 2 –19. Observation of postoperative fever (n = 3), surgery-related causes postoperative pain (n= 6), delayed oral diet = 1, retained abdominal drain = 4, and postoperative complications (n= 3). Bowel injury (n = 2) and septicemia (n = 1) were serious postoperative consequences resulting in more prolonged hospital stay. PONV (n = 2), medical causes (n = 3), and patient preference (n = 7) were among the reasons for the prolonged hospital stay. Conclusion: While our study has a few limitations; it is a retrospective review with nonrandomized patient selection and a smaller sample size, we have established safety of day case laparoscopic cholecystectomy in select group of patients. Patients’ personal satisfaction was the most common reason for their overnight admission after day case LC which was because of number of sociodemographic factors. [ABSTRACT FROM AUTHOR]

Intestinal Ascariasis is a common helminthic infection in developing countries and in some rare cases, worms migrate to the biliary tract and gall bladder. Extraintestinal biliary ascariasis presents with jaundice, right upper quadrant abdominal pain, and vomiting. Ultrasonography is a useful diagnostic modality. Albendazole and Mebendazole are commonly used anti-helmintic agents for conservative management, whereas endoscopic removal is needed in rare cases.

Introduction: Gall bladder is the most common surgically resected specimen as gallstones are one of the major causes of morbidity. There is increasing incidence of gall stones in India and more so in North India. It can be due to changes in life style such as fat rich food and sedentary life style. Stones can produce a wide variety of mucosal changes ranging from inflammatory, metaplastic, dysplastic and neoplastic lesions. Aim: This study was performed to find out the spectrum of histopathological lesions in gall bladder in cholecystectomy specimens with or without stones. Materials and Methods: This was a hospital based cross- sectional study conducted on 415 cholecystectomy specimens received between 1st November 2019 to 31st October 2020 in the department of Pathology of NCR Institute of Medical Sciences, Meerut. The specimens were received in 10% formalin, the gross details of specimens and stones were studied. Sections were taken from the representative areas, processed and stained with Haematoxylin and Eosin stain. These sections were studied meticulously. Demographic data was expressed as percentages. The p-value was calculated by chi-square test. Results: Of the 415 cholecystectomy specimens 337 were from females and 78 were from males with female to male ratio of 4.3:1. The most common histopathological finding was chronic cholecystitis followed by cholesterolosis observed in 206/231 (89.17%) and 28/31 (90.32%) respectively in gall bladders with stones and in 25/231 (10.82%) and 3/31 (9.36%) of gall bladders without stones. Metaplasia and dysplasia was found in 81/83 (97.59%) and 15/16 (93.75%) of cases with stones, and in 2/83 (2.40%) and 1/16 (6.25%) cases without stones. Conclusion: Cholelithiasis produces diverse mucosal alterations some of which are precancerous and can progress to cancer. So, histopathological examination of all the gall bladders is essential for the detection of premalignant and malignant conditions.

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.

Background and objective: Although cholecystectomy relieves symptoms in the majority of cases, still a significant number of patients suffer from the post-cholecystectomy syndrome. Cystic duct remnant calculi is a causative factor of the post-cholecystectomy syndrome. Cystic duct stones are not infrequently encountered during laparoscopic cholecystectomies. This study aimed to present our experience of patients with calculi of the cystic duct that successfully dealt with laparoscopically. Methods: This study was conducted on 4000 cases of chronic calculous cholecystitis at Rizgary Teaching Hospital from January 2010 to November 2020. Results: Cystic duct stones were detected in 397 cases. A single stone was found within the cystic duct in 301 patients (75.8%) and multiple stones in 96 patients (24.2%). The cystic duct was reported to be wider than normal in 368 cases (92.7%) and near to normal in 29 cases (7.30%). We recorded two cases (0.5%) of concomitant common bile duct stones with cystic duct stones. Our procedure for dealing with cystic duct stone was successful in 372cases (93.7%). Milking the stone back to the gall bladder was successful in 15 cases (3.80%). In eight cases (2.00%), we were obliged to convert the procedure to open cholecystectomy. Since peroperative cholangiography and choledcoscopy are not available in our hospital, the associated common bile duct stone in two cases (0.50%) was postponed and dealt with later on. Post-operative recovery was uneventful, apart from one patient who developed features of acute cholangitis. Conclusion: Cystic duct stones are not infrequent, as was believed earlier. Their preoperative detection may be difficult, but it can be detected easily peroperatively. Its detection and retrieval are mandatory to decrease the incidence of post-cholecystectomy phenomena.

Extramedullary plasmacytoma (EMP) is a rare disease consisting of the presence of monoclonal plasma cells in tissues other than the bone. Most EMPs are located in the head and neck region. We present an extremely rare case of an EMP originating from the biliary tract in a 76-year-old male. This is the fifth report of a primary EMP arising from the biliary tract. He was diagnosed with jaundice, and he was referred for an additional examination. Abdominal ultrasonography revealed a tumor in the gallbladder and bile ducts, and a bile duct biopsy was performed via endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The pathological and immunohistochemical examination revealed that the tumor was a plasmacytoma originating in the biliary tract. Although endoscopic biliary drainage was performed, the bile duct infection was not well controlled due to obstructive jaundice caused by the tumor. Furthermore, the bleeding from the tumor during chemotherapy was uncontrolled. Pancreaticoduodenectomy and cholecystectomy were performed to control the infection and bleeding. Although chemotherapy was continued after surgery, the tumor of the intrahepatic bile duct enlarged. He died seven months after the diagnosis because of the treatment-resistant tumor. [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: 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]