Gross wall thickening and murky thick fluid with

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Gross wall thickening and murky, thick fluid with sediments and a pericholecystic collection suggest an empyema or pyocele of the gallbladder. Plain radiography of the abdomen may show a soft-tissue–density shadow with an intraluminal calcific shadow in the subhepatic region. This finding alone is nonspecific and should only be used as a guideline in differential diagnosis. Scintigraphy (hepato-iminodiacetic acid [HIDA] scan) may be indicated in obscure cases, although it can only offer indirect evidence. Nonvisualization of the gallbladder indicates an obstructed gallbladder and possible acute cholecystitis; nonvisualization in the small intestine indicates CBD obstruction. Computed tomography (CT) scanning may be indicated in cases in which the diagnosis is unclear or in which other associated conditions and/or complications must be assessed. The gallbladder is well visualized, and the wall and contents can be assessed; however, stones may be difficult to identify. Associated hepatic conditions, pancreatitis, and complications such as an abscess formation and perforation of the gallbladder may be better assessed with a CT scan. Medical Therapy Do not consider a medical line of management with oral dissolution therapy in obstructed gallbladders. In acalculous hydrops observed in children as a part of a wider spectrum, expectant management may be considered. Surgical Therapy 8
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Cholecystectomy is the definitive treatment for an obstructed gallbladder. Laparoscopic cholecystectomy is the criterion standard procedure. (A 2009 study derived from database information and a literature review found evidence that even when gallstones are absent in patients with RUQ pain and a positive HIDA scan, symptom relief is more likely to occur following cholecystectomy than it is after medical treatment. ) Open cholecystectomy may be performed in patients with a very large gallbladder, with greatly thickened gallbladder walls, and with an obliterated Calot triangle, in whom laparoscopic dissection could be difficult and time-consuming. In some patients, percutaneous (ultrasonographically guided) or open cholecystostomy may be used as a temporary measure; cholecystostomy is usually performed in patients who are very sick or when the dissection is technically very difficult. A subsequent completion cholecystectomy may be carried out once the initial condition improves. Intraoperative Details Intraoperative aspiration of the large gallbladder helps to facilitate grasping the gallbladder for dissection. Intraoperative cholangiography is indicated, depending on clinical and investigative features that may suggest CBD obstruction. Complications Bacterial contamination of the bile leads to an empyema of the gallbladder; the patient usually has a toxic and ill appearance. Gas-producing organisms may lead to an emphysematous gallbladder; air bubbles in the wall of the gallbladder are visualized using plain radiography, ultrasonography, or CT scanning.
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  • Winter '18
  • Jane doe
  • Digestive System, bile duct, Hepatology, Gallstone

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