Search Results (167)

The gallbladder pathology is mainly represented by cholelithiasis, treated with cholecystectomy, one of the most commonly performed surgical procedures, continues to raise some challenges. Despite the advancements in surgical techniques, especially in those patients presenting some particularities, such as cirrhotic patients or those with sclero-atrophic or acute gangrenous cholecystitis, difficulties continue to arise. This review, including an evaluation of the literature from the last 20 years, aims to explore the pathophysiological mechanisms and surgical approaches for these high-risk conditions. Emphasis is placed on tailoring management strategies in order to reduce complications and improve outcomes, offering insights for optimizing care in difficult cholecystectomies. Full article

Background: This systematic review aimed to comprehensively evaluate the clinical, diagnostic, and therapeutic features of synchronous acute cholecystitis (AC) and acute appendicitis (AAP). Methods: The review protocol was prospectively registered in PROSPERO (CRD420251086131) and conducted in accordance with PRISMA 2020 guidelines. A systematic search was performed across PubMed, MEDLINE, Web of Science, Scopus, Google Scholar, and Google databases for studies published from January 1975 to May 2025. Search terms included variations of “synchronous,” “simultaneous,” “concurrent,” and “coexistence” combined with “appendicitis,” “appendectomy,” “cholecystitis,” and “cholecystectomy.” Reference lists of included studies were screened. Studies reporting human cases with sufficient patient-level clinical data were included. Data extraction and quality assessment were performed independently by pairs of reviewers, with discrepancies resolved through consensus. No meta-analysis was conducted due to the descriptive nature of the data. Results: A total of 44 articles were included in this review. Of these, thirty-four were available in full text, one was accessible only as an abstract, and one was a literature review, while eight articles were inaccessible. Clinical data from forty patients, including two from our own cases, were evaluated, with a median age of 41 years. The gender distribution was equal, with a median age of 50 years among male patients and 36 years among female patients. Leukocytosis was observed in 25 of 33 patients with available laboratory data. Among 37 patients with documented diagnostic methods, ultrasonography and computed tomography were the most frequently utilized modalities, followed by physical examination. Twenty-seven patients underwent laparoscopic cholecystectomy and appendectomy. The remaining patients were managed with open surgery or conservative treatment. Postoperative complications occurred in five patients, including sepsis, perforation, leakage, diarrhea, and wound infections. Histopathological analysis revealed AAP in 25 cases and AC in 14. Additional findings included gangrenous inflammation and neoplastic lesions. Conclusions: Synchronous AC and AAP are rare and diagnostically challenging conditions. Early recognition via imaging and clinical evaluation is critical. Laparoscopic management remains the preferred approach. Histopathological examination of surgical specimens is essential for identifying unexpected pathology, thereby guiding appropriate patient management. Full article

Pancreatic cancer is an aggressive malignancy, with a current 5-year survival rate in the United States of approximately 13.3%. Although the current standard for resectable pancreatic cancer most commonly includes neoadjuvant chemotherapy prior to a curative resection, surgery, in the majority of patients, has historically been palliative. The latter interventions include open or laparoscopic bypass of the bile duct or stomach in cases of obstructive jaundice or gastric outlet obstruction, respectively. Non-surgical interventional therapies started with percutaneous transhepatic biliary drainage (PTBD), both as a palliative maneuver in unresectable patients with obstructive jaundice and to improve liver function in patients whose surgery was delayed. Likewise, interventional radiologic techniques included the placement of plastic and ultimately self-expandable metal stents (SEMSs) through PTBD tracts in patients with unresectable cancer as well as percutaneous cholecystostomy in patients who developed cholecystitis in the context of malignant obstructive jaundice. Endoscopic retrograde cholangiopancreatography (ERCP) and stent placement (plastic/SEMS) were subsequently used both preoperatively and palliatively, and this was followed by, or undertaken in conjunction with, endoscopic gastro-duodenal SEMS placement for gastric outlet obstruction. Although endoscopic ultrasound (EUS) was initially used to cytologically diagnose and stage pancreatic cancer, early palliation included celiac block or ablation for intractable pain. However, it took the development of lumen-apposing metal stents (LAMSs) to facilitate a myriad of palliative procedures: cholecystoduodenal, choledochoduodenal, gastrohepatic, and gastroenteric anastomoses for cholecystitis, obstructive jaundice, and gastric outlet obstruction, respectively. In this review, we outline these procedures, which have variably supplanted surgery for the palliation of pancreatic cancer in this rapidly evolving field. Full article

Background: Acute complicated cholecystitis (ACC) is associated with prolonged hospitalization, increased morbidity, and higher mortality. However, objective imaging-based criteria to guide early clinical decision-making remain limited. This study aimed to develop a predictive scoring system integrating clinical characteristics, laboratory biomarkers, and computed tomography (CT) findings to facilitate the early identification of ACC in the emergency department (ED). Methods: We conducted a retrospective study at an urban tertiary care center in Taiwan, screening 729 patients who presented to the ED with suspected cholecystitis between 1 January 2018 and 31 December 2020. Eligible patients included adults (≥18 years) with a confirmed diagnosis of acute cholecystitis based on the Tokyo Guidelines 2018 (TG18) and who were subsequently admitted for further management. Exclusion criteria included (a) the absence of contrast-enhanced CT imaging, (b) no hospital admission, (c) alternative final diagnosis, and (d) incomplete clinical data. A total of 390 patients met the inclusion criteria. Demographic data, laboratory results, and CT imaging features were analyzed. Logistic regression and decision tree analyses were used to construct predictive models. Results: Among the 390 included patients, 170 had mild, 170 had moderate, and 50 had severe cholecystitis. Key predictors of ACC included gangrenous changes, gallbladder wall attenuation > 80 Hounsfield units, CRP > 3 mg/dL, and WBC > 11,000/μL. A novel scoring system incorporating these variables demonstrated good diagnostic performance, with an area under the curve (AUC) of 0.775 and an optimal cutoff score of ≥2 points. Decision tree analysis similarly identified these four predictors as critical determinants in stratifying disease severity. Conclusions: This CT- and biomarker-based scoring system, alongside a decision tree model, provides a practical and robust tool for the early identification of complicated cholecystitis in the ED. Its implementation may enhance diagnostic accuracy and support timely clinical intervention. Full article

Background: This study investigated the reasons for transferring patients to tertiary hospitals due to complications arising after surgery at orthopedic specialty hospitals and the treatment results. Methods: This retrospective cohort study was conducted on all orthopedic patients, except for the spine, at a single institution from January 2012 to May 2022. Results: Of 67,118 patients, 167 (0.24%) were transferred to a tertiary hospital after surgery. Patients’ average age was 72.2 ± 9.2 years (range: 28–91 years), and there were 34 men and 133 women. The most common reason for transfer to a tertiary hospital was pulmonary embolism (27 patients, 16.2%), which occurred on an average 3.81 days (range: 0–23 days) after surgery, and 25 patients were transferred within 1 week after surgery. The next most common cause was acute cholecystitis (19 patients (11.4%), all of whom had undergone total knee arthroplasty), which occurred on an average 6.15 days (range: 1–14 days) after surgery. Conclusions: The rate of transfer from the orthopedic hospital where this study was conducted to a tertiary hospital was very low at 0.24%. Pulmonary embolism, acute cholecystitis, and cerebral infarct were the most common reasons for transfer. In particular, acute cholecystitis was the second most common reason for transfer, and caution should be taken because elderly patients may experience only atypical clinical symptoms without abdominal pain or tenderness even the day after surgery. Full article

Background and Objectives: Early cholecystectomy (EC) is widely regarded as the first-line treatment for acute calculous cholecystitis (ACC). Current debate centers on the feasibility of EC as an option even for elderly patients. This study aims to determine whether age alone is an independent risk prediction factor for prognosis after EC for ACC. Materials and Methods: This study is a post-hoc analysis of the S.P.Ri.M.A.C.C. WSES prospective international multicenter observational study database, including patients with ACC undergoing EC. Univariate and multivariate analyses were conducted, examining different risk factors for major morbidity and mortality after EC. Results: In the univariate analyses, age was found to be a statistically significant risk factor for both 30-day major complications (p < 0.001) and 30-day mortality (p = 0.003). However, in the multivariate analysis, age alone was not a significant predictor for either outcome, with p-values of 0.419 and 0.094, respectively. The only significant risk factor associated with both 30-day mortality and major morbidity in the multivariate model was the POSSUM Physiological Score (PS). Conclusions: Age alone cannot be considered a reliable risk predictor for a complicated postoperative course after EC in patients with ACC. Frailty, rather than chronological age, should be assessed to predict the outcome of these patients. Full article

Approximately 17,000 bears undergo bile extraction in facilities across Asia for traditional medicines despite the availability of proven alternatives. Bears are confined to cages and bile harvested from the gallbladder via needle aspiration, implanted catheters, or transabdominal fistulas. Bile-extracted bears develop numerous detrimental conditions, including abnormal repetitive behaviors, emaciation, dental disease, cholecystitis, hernias, abscesses, and neoplasia. A high prevalence of aortic dilation, commonly seen with systemic hypertension, was reported in bile-extracted bears, and aortic aneurysm rupture/dissection was the third leading cause of death in a population of 600 formerly bile-extracted bears. A high incidence of renal disease, a common cause of systemic hypertension in other species, was also identified in this population. We hypothesized that renal disease was positively correlated with lesions of systemic hypertension in bile-extracted bears. Archived medical records, imaging, and samples from 180 formerly bile-extracted bears were analyzed. Hypertensive retinopathy, left ventricular hypertrophy, and aortic dilation were used as validated correlates of systemic hypertension. The majority (76.1%) of bears exhibited at least one systemic hypertension lesion, and 62.8% had two or more lesions. Left ventricular hypertrophy was most common, followed by aortic dilation/aneurysm. Lesions of systemic hypertension were positively correlated to renal disease parameters of serum creatinine and renal histopathology. Understanding the etiology of systemic hypertension in this population is critical due to consequent comorbidities and increasing numbers of bile-extracted bears finding their way to sanctuary. Full article

The Bosniak classification categorizes renal cystic lesions based on cross-sectional imaging features from clearly benign (Bosniak type I) to malignant lesions (Bosniak type IV). A 67-year-old female patient presented to the emergency department with typical symptoms of acute cholecystitis. During a transabdominal ultrasound examination, an incidental finding was a suspicious cluster of anechoic cystic lesions with internal septa in the left kidney. Following contrast-enhanced computed tomography (CT), the lesion was categorized as a Bosniak type IV cyst. Compared to an earlier CT scan, a Bosniak type I cyst preceded the current Bosniak type IV cyst, suggesting a malignant alteration over the 7-year interval. It was surgically removed, and pathohistological analysis revealed cystic renal cell carcinoma. Although simple renal cysts rarely become malignant, scientific discussion about potential algorithms for additional surveillance is needed. Full article

Background/Objectives: The surge in migration from the Middle East and North Africa due to conflicts has significantly impacted healthcare systems, particularly in Greece. This study investigates how the sharp increase in refugees and migrants after July 2015 has strained the surgical departments of the Greek National Health System (NHS). Methods: A retrospective analysis was conducted on 229 patients treated at the emergency department of a public hospital in Athens, Greece. Data were compared between two periods: January 2012–July 2015 (pre-July 2015) and July 2015–December 2018 (post-July 2015), with July 2015 chosen as the cutoff due to a significant influx of immigrants during that time. Results: Patients’ demographic details, diagnoses, and surgical interventions were analyzed. Results indicated a significant rise in surgical cases, with 72.5% of patients requiring procedures, notably for appendicitis (23.6%), cholecystitis (10.9%), lower extremity thrombophlebitis (9.6%), perianal abscess (8.3%), and inguinal hernia (5.7%). Post-July 2015, there was a notable increase in perianal abscess (12.2%), inguinal hernia (8.4%), and cholelithiasis (6.1%). However, the average hospital stay of 3.9 days remained unchanged. Conclusions: The findings reveal the profound economic and operational pressures on the NHS during the refugee crisis, highlighting the urgent need for resource optimization and policy reforms. Future studies should address long-term healthcare impacts to support more sustainable healthcare models amidst ongoing and future migration challenges. Full article

Gallbladder carcinoma (GBC) is one of the most aggressive malignancies of the biliary tract, often originating from chronic inflammation associated with gallstones and cholecystitis. Persistent inflammation plays a pivotal role in the development of preneoplastic changes, such as metaplasia, which may progress to malignancy. Despite its relatively low incidence, GBC is characterized by a poor prognosis due to late-stage diagnosis, highlighting the urgent need for improved early detection strategies. This study aimed to assess the diagnostic and prognostic significance of CA 19-9 and CEA levels in patients with gallbladder lesions, while also evaluating systemic inflammation and hemostatic dysregulation. A retrospective analysis was conducted on patients diagnosed with gallbladder lesions, with histopathological confirmation of adenocarcinoma and metaplasia. Laboratory assessments included serum levels of tumour markers, inflammatory markers such as CRP, and key hemostatic parameters, including thrombocyte count, prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen levels. A predictive scoring model was developed using the cutoff values of CA 19-9 and CEA to assess their combined diagnostic potential. Among the patients studied, 48.9% had an initial diagnosis of chronic cholecystitis, while 32.2% presented with acute cholecystitis. Adenocarcinoma was identified in 6.7% of cases after histopathological examination, predominantly in females over 65 years old with acute cholecystitis. Metaplasia was detected in 7.8% of cases, primarily in elderly females with chronic cholecystitis. Laboratory findings revealed significantly elevated levels of CA 19-9, CEA, AFP, and CA-125 in patients with adenocarcinoma. Additionally, abnormalities in hemostatic parameters, including increased fibrinogen levels and alterations in thrombocyte count, were observed in patients with malignancy. A combined predictive score using CA 19-9 and CEA demonstrated strong potential for detecting adenocarcinoma and metaplasia, improving diagnostic accuracy. Our findings emphasize the clinical importance of integrating tumour markers, inflammatory biomarkers, and hemostatic parameters in the evaluation of gallbladder lesions associated with chronic inflammation. The combined assessment of these factors enhances early detection, facilitates malignancy risk stratification, and improves prognostic evaluation, particularly in patients with metabolic and cardiovascular comorbidities. Full article

The worldwide prevalence of gallstones (GSs) is estimated to be between 10% and 15% in the general population. Gallbladder carcinoma (GBC) is the most common biliary tract neoplasia, and it is characterized by highly aggressive behavior and poor overall prognosis. Long-standing GSs and chronic inflammatory state represent the most common risk factors for GBC, promoting a carcinogenic microenvironment. Long-standing GSs expose patients to potentially severe surgical and oncological complications. A 71-year-old gentleman, who had never experienced biliary symptoms and had diabetes mellitus (DM), presented with severe peritonitis due to perforated acute calculous cholecystitis. The patient underwent an emergent laparotomic cholecystectomy. Histopathology found a rare pT2b poorly differentiated squamocellular carcinoma of the gallbladder. Although more difficult due to the concomitant inflammatory context, it is critical to identify suspicious lesions during preoperative imaging in patients at high risk of malignancy presenting with complex acute gallbladder pathologies. A review of the literature was conducted to gain a deeper insight into the relationship between long-standing GSs and GBC, evaluating also the difficult diagnosis and management of malignancy in the acute setting. Considering the existing literature, the choice to pursue a prophylactic cholecystectomy may be justifiable in selected asymptomatic GS patients at high risk for GBC. Full article

Membranous nephropathy (MN) is a disease with an etiology and pathogenesis that are still not fully understood, and it represents a great challenge. It is characterized by a variable course, spontaneous remissions and relapses. The inability to rely entirely on antibodies and the continuous threat of a malignant disease make the differentiation of MN types extremely difficult. Data of twelve patients with membranous nephropathy, ranging in age between 28 and 67 years, are presented; in total, seven men and five women were observed for a period of 2 to 10 years. In all patients, the diagnosis was confirmed through kidney biopsy and laboratory tests, including immunological, histopathological, and immunohistochemical tests. Histopathological and immunohistochemical tests were applied on available material from the thyroid gland in two patients and the gallbladder in two patients with MN. Data of 102 patients with MN and their comorbidities are evaluated in order to establish correlations. These and other data are used to build a hypothetical pathogenetic model that explains the etiology and the likely pattern of disease occurrence. We found a connection between chronic cholecystitis, thyroiditis, hepatitis, and other diseases in the occurrence of MN and disease course. From our practice and cases, we drew the conclusion that chronic inflammation in sites that express PLA2R leads to the formation of antibodies against PLA2R. These antibodies occur as a preformed immune complex or separately and are deposited in the subepithelial space, leading to MN appearance. Full article

Background/Objectives: Early detection and diagnosis are important when treating gallbladder (GB) diseases. Poorer clinical outcomes and increased patient symptoms may result from any error or delay in diagnosis. Many signs and symptoms, especially those related to GB diseases with similar symptoms, may be unclear. Therefore, highly qualified medical professionals should interpret and understand ultrasound images. Considering that diagnosis via ultrasound imaging can be time- and labor-consuming, it may be challenging to finance and benefit from this service in remote locations. Methods: Today, artificial intelligence (AI) techniques ranging from machine learning (ML) to deep learning (DL), especially in large datasets, can help analysts using Content-Based Image Retrieval (CBIR) systems with the early diagnosis, treatment, and recognition of diseases, and then provide effective methods for a medical diagnosis. Results: The developed model is compared with two different textural and six different Convolutional Neural Network (CNN) models accepted in the literature—the developed model combines features obtained from three different pre-trained architectures for feature extraction. The cosine method was preferred as the similarity measurement metric. Conclusions: Our proposed CBIR model achieved successful results from six other different models. The AP value obtained in the proposed model is 0.94. This value shows that our CBIR-based model can be used to detect GB diseases. Full article

Gallstone disease (GSD) is a common gastrointestinal disorder affecting approximately 10–20% of the global adult population, characterized by the presence of gallstones, predominantly cholesterol-based, in the gallbladder and/or biliary ducts. While many patients remain asymptomatic, more than 20% develop clinical symptoms such as abdominal pain, nausea, vomiting, jaundice, and anorexia, potentially leading to severe complications like acute cholecystitis and biliary pancreatitis. GSD has a significant genetic predisposition, with the variable prevalence of the disease according to ethnicity being highest in American and European countries and lowest in Asian and African populations. Numerous genes encoding membrane transporters involved in bile metabolism are associated with GSD, including in particular members of ATP-binding cassette transporters and others, which affect bile lithogenicity and contribute to the development of gallstones. Specific mutations in these genes are linked to an increased risk of gallstone formation, especially in individuals with certain hereditary conditions such as hemolytic diseases, thyroid disorders, and hyperparathyroidism. Advances in genetic studies have identified new variants that influence the risk of cholelithiasis, although the exact mechanisms remain partially understood in many cases. This review briefly summarizes the genetic causes of cholelithiasis, highlighting various pathogenetic mechanisms. It presents the currently used treatments and the potential implications of widely applied genetic diagnostics. Full article

Background: The rising rates of gallstones and cholecystectomy in pediatric populations underscore the increasing concern regarding chronic cholecystitis. However, the morphopathogenesis of pediatric calculous cholecystitis is still not well understood. This study aimed to determine the expression and distribution of immunomodulatory factors interleukin-12 (IL-12), interleukin-13 (IL-13), interleukin-1β (IL-1β), sonic hedgehog protein (SHH), nuclear factor NF-kappa-B p65 subunit (NFkBp65), and heat shock protein 60 (HSP60) in the gallbladder walls of pediatric patients with chronic calculous cholecystitis. Methods: In total, 11 gallbladder samples were collected from pediatric patients with calculous cholecystitis during cholecystectomy, while 5 healthy gallbladder samples served as controls. IL-12, IL-13, IL-1β, SHH, NFkBp65, and HSP60 were detected by immunohistochemistry. The number of positive structures in gallbladder wall epithelium, vasculature, and inflammatory infiltrate was assessed semi-quantitatively by microscopy. A Mann–Whitney U test and Spearman’s rank-order correlation coefficient were calculated. Results: Statistically significant differences were observed between patient and control samples in the expression of IL-1β, SHH, and NFkBp65 in the epithelium, as well as in the expression of IL-12, SHH, and HSP60 in the blood vessels. The expression of IL-1β was stronger in the epithelium of controls, while other markers were more prominent in patient samples. Conclusions: An increased number of NFkBp65, IL-12, and HSP60 positive cells in patient gallbladder tissue suggests a significant role of these tissue factors in driving immune modulation and sustaining the inflammation in pediatric chronic calculous cholecystitis. The noticeable expression of SHH in patient gallbladder tissue indicates its part in tissue regeneration and repair processes, as well as in modulating inflammation and vascular responses in calculous cholecystitis. The significant positive correlations between the factors studied highlight the importance of their coordinated interaction and intricate crosstalk in the morphopathogenesis of calculous cholecystitis. Full article