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Surgery is still the recommended and proven effective management for cholelithiasis. However, when surgery poses more risk than benefits or if surgical management is refused, oral dissolution therapy may be a helpful alternative, providing patients relief from biliary colic and preventing further formation and accumulation of gallstones while therapy is ongoing.
For Group A patients histopathological evidence was consistent with the findings of acute cholecystitis with acute cholelithiasis. For Group C patients histopathological examination showed adenocarcinoma in 5 cases and showed atypical changes suggestive of malignancy in a single case.
All the patients who had right hypochondriac pain and diagnosed with cholelithiasis on USG were included in the study.
It should also be noted in this patient's case that there was no difficult dissection, pressurization of the biliary tree by cholangiography, or even Mirizzi syndrome due to cholelithiasis. A limitation of our case presentation is that while we have both the urine culture and subcapsular biloma fluid culture confirming the presence of Pseudomonas aeruginosa with the same sensitivities and therefore a likely source, there however was no culture obtained intraoperatively of the purulent fluid in the right upper quadrant.
Four (8%) patients were given cholelithiasis or pseudolithiasis gall bladder on MRCP which was also seen either on gall bladder ultrasound or peroperatively.
Since Mouret performed first laparoscopic cholecystectomy in 1987, it has become a gold standard in treatment of cholelithiasis. The first known laparoscopic cholecystectomy in situs inversus has been reported by Campos and Sipes in 1991.
They presented with symptomatic cholelithiasis. Bile was aspirated peroperatively before cholecystectomy from gall bladder and was sent for culture and sensitivity test.
After confirming the diagnosis of cholelithiasis by ultrasonography, preoperative workup included blood tests like complete blood counts, liver function tests and hepatitis B and C screening.
Increased access to ultrasound for patients presenting with pain abdomen, has led to an increase in the diagnosis of cholelithiasis, as its symptomatology overlaps many upper GI lesions, the incidental finding of gall stones on ultrasound may mask the co-existing UGI lesions.
Cholelithiasis, cholecystitis, and bile duct malignancies have been implicated as etiologies of cholecystopathy.
Chronic recurrent cholelithiasis is the most important cause of bilioenteric fistula.
Cholelithiasis is a common problem among masses and two to three percent of asymptomatic patients become symptomatic each year.1 Laparoscopic cholecystectomy was introduced as an alternative to conventional open gallbladder removal, by Mouret in 1987 and it soon became gold standard for the surgical treatment of cholelithiasis.2,3 Role of routine sub hepatic drainage after Laparoscopic cholecystectomy is still an issue of great debate.4,5 An intra-abdominal drainage inserted as an early warning system may not always detect a nearby fluid collection and it also poses risk of liver, vascular and potentially a visceral injury.
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