Published online Jan 31, 2009.
https://doi.org/10.4174/jkss.2009.76.1.43
Beneficial Effect of Cholecystography following PGBD for Complicated Acute Cholecystitis: Detection of Unsuspected CBD Stone
Abstract
Purpose
Frequency of combined CBD stones on cholelithiasis has been known to range 5~20% in several reports, and diagnostic tools are USG, MDCT, MRCP and ERCP. Predictive factors of CBD stone for cholelithiasis were diameter of CBD, elevated liver enzyme, multiple small sized GB stones and concurrent pancreatitis. However, unsuspected CBD stone for acute cholecystitis is troublesome for patients and surgeons.
Methods
We retrospectively reviewed Percutaneous gallbladder drainage (PGBD) for acute complicated cholecystitis from October 1996 to October 2006. Indications for PGBD are clinical symptoms (sepsis) & signs of peritonitis and radiologic findings such as GB empyema, gangrenous cholecystitis and pericholecystic fluid collection. Total laparoscopic cholecystectomy was 1,357 cases, and PGBD for acute complicated cholecystitis was 13.8%.
Results
Combined CBD stone rate was 13.6%. Whereas, unsuspected CBD stone was 0.5% (9 cases), 7 in calculous and 2 in acalculous cholecystitis. No. of stone was 1 in 7 cases, 2 in 1 case and 3 in 1 case. Size of stone was less than 5 mm in all cases. Diameter of CBD was not increased in all cases (less than 1 cm) and liver enzymes showed no elevation in all cases. Management for unsuspected CBD stone was preoperative endoscopic lithotripsy in 8 cases and postoperative fluoroscopic lithotripsy in 1 case.
Conclusion
Cholecystography following PGBD for acute complicated cholecystitis is a useful diagnostic modality for detection of unsuspected CBD stone.
Table 1
Comparison of PGBD group and Non-PGBD group in patients with complicated cholecystitis
Table 2
Clinical analysis of patients with unsuspected CBD stone
References
-
Thierry M, Simon M, Alain C, Claude R, Nathalie B, Jean-Marie H, et al. Diagnosis of asymptomatic common bile duct stones: preoperative endoscopic ultrasonography versus introperative cholangiography - a multicenter, prospective controlled study. Surgery 1988;124:6–13.
-
-
Kim JS, Cho BS, Kang YJ, Park JS. Effect of percutaneous cholecystostomy on laparoscopic cholecystectomy. J Korean Surg Soc 2001;60:78–82.
-
-
Haim P, Rivka Z, Eran R, Igal G, Eugene K, Mordechai G. Prospective evaluation of patients with acute cholecystitis treated with percutaneous cholecystostomy and interval laparoscopic cholecystectomy. Int J Surg 2006;4:101–105.
-
-
Kim DG, Oh CH, Kim GH, Park BG, Kim WG. Percutaneous gallbladder drainage for delayed laparoscopic cholecystectomy in patients with acute cholecystitis. Kor J HBP Surg 2001;60:78–82.
-
-
Matthew EC, Lori S, Crolyn K, Wells MA, Danna KA, Mark T. Prediction of bile duct stone and complication in gallstone pancreatitis using early laboratory trends. Am J Gastroenterol 2001;96:3305–3311.
-
-
Kenny PK, William L. Do preoperative indicators predict the presence of common bile duct stones during laparoscopic cholecystectomy? Am J Surg 1996;171:495–499.
-
-
Rémi H, Thierry P, Bernadette D, Marcelo S, Jean-François S. Predicting common bile duct lithiasis: determination and prospective validation of a model predicting low risk. Am J Surg 1995;170:38–43.
-
-
Shintaro K, Hiroyuki I, Masaski A, Nobuo T, Naoki S, Yosuke N, et al. Detection of common bile duct stone; comparison between endoscopic ultrsonography, magnetic resonance cholangiography and helical-computed-tomography. Eur J radiol 2005;54:271–275.
-
-
Byron EW, Martin LF, John KC, Robert RQ, Aloke KM. Current management of common bile duct stones: is there a role for laparoscopic cholecystectomy and intraoperative endoscopic retrograde cholangiopancreatography as a single-stage procedure? Surgery 2002;132:729–737.
-
-
Seyed AM, Mehdi M, Jafar N, Ahad AV, Ramin G, Reza M. Prospective evaluation of endoscopic ultrasonography in the diagnosis of biliary microlithiasis in patients with normal transabdominal ultrasonography. J Gastrointest Surg 2005;9:961–964.
-
-
Brian EL, Gina A, Richard WS. Choledocholithiasis - principles of diagnosis and management. Curr Surg 2004;61:290–293.
-
MeSH Terms
Tables
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