1/11. leptospirosis mimicking acute cholecystitis among athletes participating in a triathlon.leptospirosis, a disease acquired by exposure to contaminated water, is characterized by fever accompanied by various symptoms, including abdominal pain. An acute febrile illness occurred in athletes who participated in an illinois triathlon in which the swimming event took place in a freshwater lake. Of 876 athletes, 120 sought medical care and 22 were hospitalized. Two of the athletes had their gallbladders removed because of abdominal pain and clinical suspicion of acute cholecystitis. We applied an immunohistochemical test for leptospirosis to these gallbladders and demonstrated bacterial antigens staining (granular and filamentous patterns) around blood vessels of the serosa and muscle layer. Rare intact bacteria were seen in 1 case. These results show that leptospirosis can mimic the clinical symptoms of acute cholecystitis. If a cholecystectomy is performed in febrile patients with suspicious environmental or animal exposure, pathologic studies for leptospirosis on formalin-fixed, paraffin-embedded tissues may be of great value.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/11. Acute acalculous cholecystitis associated with cholecystoduodenal fistula and duodenal bleeding. A case report.Although acute acalculous cholecystitis (AAC) accounts for less than 10% of acute cholecystitis in the adult population, gangrene and perforation are much more frequent compared to the usual cases of acute cholecystitis (calculus cholecystitis). However, spontaneous biliary-enteric fistula is well recognized in AAC, 90% of which are cholecystoduodenal fistula (CDF) though it is an uncommon disorder. The majority of the CDF are caused by cholelithiasis. As patients are usually associated with complicated clinical illness, the diagnosis is often difficult to make and required surgery is often delayed. We have studied a rare complication of acute acalculous cholecystitis which was presented as intermittent upper gastrointestinal bleeding. Ulceration of the superficial branch of the cystic artery has been observed due to acalculous cholecystitis associated with a cholecystoduodenal fistula. We have performed a transfixing ligation of the bleeding vessel, cholecystectomy and simple closure of the CDF. We have finally made a diagnosis of early gallbladder cancer through a frozen section. There was no serious complication after the operation and the patient has achieved an uneventful recovery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/11. An unusual case of cholecystitis.A 56-year-old woman with diabetes who had undergone a coronary artery bypass surgery for triple-vessel coronary artery disease presented 2 weeks after discharge with classic features of cholesterol embolization, blue toes, renal insufficiency, and intractable abdominal pain. Despite a multitude of investigations, the cause of her abdominal pain was elusive. Laparoscopic cholecystectomy revealed the cause: acute cholecystitis secondary to cholesterol crystal embolization. Although rare, cholecystitis as a manifestation of cholesterol embolization can occur, and prompt recognition will prevent unnecessary investigations and ensure immediate treatment.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/11. Omental torsion: CT features.A 33-year-old male presented to the emergency department complaining of right upper quadrant pain and was initially diagnosed with acute cholecystitis. Abdominal computed tomography showed a whirling pattern of fatty streaks and vessels within the greater omentum, and surgery confirmed infarction of the omentum secondary to torsion. We report a case of surgically and pathologically proven omental torsion that demonstrated the typical whirling appearance on computed tomography.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/11. The role of prophylactic intra-aortic balloon pump counterpulsation (IABP) in emergency non-cardiac surgery.patients with recent myocardial infarction (MI), congestive heart failure, severe angina, or uncorrected multivessel coronary artery disease are at increased risk of cardiac complications after urgent major non-cardiac surgery. Although invasive haemodynamic monitoring and preoperative optimization of cardiac status may lead to some reduction in the rate of perioperative cardiac events, the mortality from such events still remains high. The use of an intra-aortic balloon pump (IABP) may play a role in such patients by improving the function of the injured heart. We report our experience with the use of perioperative IABP in a patient with unstable angina and recent MI who underwent urgent cholecystectomy. There were no perioperative cardiac events while the IABP was in place. The anaesthetic concerns, intraoperative and postoperative monitoring and care and usefulness of IABP will be discussed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/11. Systemic lupus erythematosus clinically resembling multiple sclerosis and with unusual pathological and ultrastructural features.A case of systemic lupus erythematosus is described which clinically resembled multiple sclerosis and in which the lesions were restricted to the central nervous system. The necropsy findings of vascular thickening and necrosis in the spinal cord and in a posterior nerve root explain the main clinical abnormalities. Clinical signs of the terminal peritonitis secondary to cholecystitis were absent or minimised probably because of the steroid therapy and spinal cord necrosis. Primary demyelination was not demonstrated though electronmicroscopy revealed lattice fibrillar inclusions within a few myelin sheaths. An unusual ultrastructural feature was the finding of "rod-shaped tubular bodies" in large numbers in the endothelial cells of cerebral blood vessels. The incidence and morphology of these organelles are compared with those of the intracisternal tubuloreticular structures (TRS) commonly found in systemic lupus erythematosus.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/11. Acute acalculous cholecystitis due to an incarcerated epigastric hernia.A case of a 96 year old woman with an incarcerated gallbladder in an epigastric hernia causing acute acalculous cholecystitis is described. At operation the gallbladder was replaced in its anatomical site and the hernia was repaired. This unique case of acute acalculous cholecystitis demonstrates cystic duct obstruction and cystic vessel compression as possible aetiologies for this pathology.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/11. rocky mountain spotted fever mimicking acute cholecystitis.rocky mountain spotted fever can present with predominantly abdominal symptoms including nausea, vomiting, diarrhea, and abdominal pain. Two elderly patients presented with an acute febrile illness and abdominal symptoms. Rash was not present initially. Workup disclosed cholelithiasis in one, and a thickened gallbladder wall surrounded by a sonolucent zone suggesting a pericholecystic abscess was found by ultrasonography in the other. Both patients underwent emergency laparotomy, with cholecystectomy in both and appendectomy in one. Both patients died several days postoperatively. Pathologic specimens reviewed later showed that multiple blood vessels of the gallbladder and the appendix were infected with rickettsia rickettsii, and there was focal vascular thrombosis and hemorrhage. These documented direct rickettsial infections and lesions in the blood vessels of abdominal viscera suggest the basis for the abdominal symptoms in rocky mountain spotted fever.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
9/11. Acute acalculous cholecystitis. An increasing entity.Acute acalculous cholecystitis was observed to increase in frequency between 1950 and 1979, an increase that was statistically significant. The greatest part of this increase occurred between 1965 and 1979. Acute acalculous cholecystitis was also found to be associated with a higher mortality rate, more than twice that of acute calculous cholecystitis. Acute acalculous cholecystitis occurred in a variety of clinical settings including bacterial sepsis, severe trauma including surgical trauma and burns, multiple transfusions, and severe debilitation. The lesion in the gallbladder consists of intense injury of blood vessels in the muscularis and serosa similar to those induced experimentally by in vivo activation of factor xii dependent pathways. Possibly because of the intensity of vascular injury, acute acalculous cholecystitis with minimal clinical manifestations may rapidly progress to gangrene with perforation. Undelayed surgical treatment, which has become more widely accepted over the past 50 years, is essential. It may have also contributed to the increased recognition of this clinical entity.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/11. Surgical complications of Kawasaki disease.Four of 10 cases of Kawasaki disease (KD), mucocutaneous lymph node syndrome, seen from 1975 to 1980 had serious surgical complications. These included gallbladder obstruction, massive necrosis of gallbladder, liver, duodenum, jejunum, and necrosis of digits of both hands. Less serious necrosis of adrenals, testes, bladder, and stomach were seen. The operative mortality rate was 25%. The etiology is unknown. The average age was 2 yr. There was no sex preponderance. The essential lesion is an arteritis and periarteritis initially involving small arteries and later the medium and large vessels.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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