RESUMO

BACKGROUND: The management of gallbladder perforation (GBP) with fistulous communication (Neimeier type I) is controversial. AIM: To recommend management options for GBP with fistulous communication. METHODS: A systematic review of studies describing the management of Neimeier type I GBP was performed according to the PRISMA guidelines. The search strategy was conducted in Scopus, Web of Science, MEDLINE, and EMBASE (May 2022). Data extraction was obtained for patient characteristics, type of intervention, days of hospitalization (DoH), complications, and site of fistulous communication. RESULTS: A total of 54 patients (61% female) from case reports, series, and cohorts were included. The most frequent fistulous communication occurred in the abdominal wall. Patients from case reports/series had a similar proportion of complications between open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) (28.6 vs 12.5; P = 0.569). Mortality was higher in OC (14.3 vs 0.0; P = 0.467) but this proportion was given by only one patient. DoH were higher in OC (mean 26.3 d vs 6.6 d). There was no clear association between higher rates of complications of a given intervention in cohorts, and no mortality was observed. CONCLUSION: Surgeons must evaluate the advantages and disadvantages of the therapeutic options. OC and LC are adequate options for the surgical management of GBP, with no significant differences.

RESUMO

Resumen Objetivo: Este estudio se llevó a cabo para valorar las consecuencias de la perforación iatrogénica de la vesícula biliar (PIVB), investigando su asociación con complicaciones posoperatorias, uso de antibióticos y drenajes, duración de la cirugía y estancia posoperatoria. Materiales y Método: Se incluyeron 1.703 pacientes con colecistectomía laparoscópica electiva, divididos en dos grupos: con PIVB (Grupo 1; n = 321) y sin PIVB (Grupo 2; n = 1.382). Se compararon los resultados entre ambos grupos. Resultados: El porcentaje de PIVB fue de 18,85%. El vertido aislado de bilis ocurrió en 241 pacientes (14,15%) y el de bilis y cálculos en 80 pacientes (4,64%). La incidencia de infección del sitio quirúrgico no fue diferente entre ambos grupos. La incidencia de PIVB fue mayor en varones (43,3% vs 31,3%), pacientes con adherencias perivesiculares (17,75% vs. 10,5%) y pacientes con diagnóstico histológico de colecistitis aguda (11,52% vs. 4,92%). La PIVB se asoció significativamente con mayor duración de la cirugía (77,3 vs. 65,4 minutos), mayor uso de drenajes y antibióticos y mayor estancia posoperatoria. No hubo complicaciones tardías. Discusión y Conclusión: La PIVB no aumenta la incidencia de infección, pero se asocia con un mayor uso de drenajes y antibióticos, mayor duración de la cirugía y mayor estancia posoperatoria.

Aim: This study was conducted to evaluate the outcomes in patients with iatrogenic gallbladder perforation (IGP), investigating its association with postoperative complications, use of antibiotics and drains, operative time and postoperative stay. Materials and Method: 1703 patients who underwent elective laparoscopic cholecystectomy were included and divided in two groups: with IGP (Group 1, n = 321) and without IGP (Group 2, n = 1382). We compared the outcomes between both groups. Results: The IGP rate was 18.85%. Isolated bile spillage occurred in 241 patients (14.15%), and stone spillage in 80 patients (4.64%). The incidence of surgical site infections was not different between both groups. The IGP rate was significantly higher in male (43.3% vs 31.3%), in patients with perivesicular adhesions (17.75% vs 10.5%) and in patients with histologic diagnosis of acute cholecystitis (11.52% vs 4.92%). Operative time was significantly longer in patients with IGP (77.3 vs 65.4 minutes). Intraoperative drain and antibiotic use, as well as postoperative stay were, also, significantly higher in patients with IGP. There was not any late complication. Conclusión: Bile and gallstones spillage do not lead to an increase in surgical site infections, but is associated with an increased use of antibiotics and drains, longer operative time and longer postoperative stay.

Assuntos

RESUMO

Resumen Introducción: La colecistitis hemorrágica es una complicación poco frecuente de la colecistitis aguda con una alta mortalidad. Materiales y Método: Paciente con dolor abdominal en hipocondrio derecho e ictericia. Los exámenes de laboratorio y ultrasonido hepatobiliar mostraron datos sugestivos de colecistitis aguda; durante su estancia hospitalaria presenta deterioro de su estado general, realizándose tomografía computarizada mostrando imágenes sugestivas de colecistitis hemorrágica y hemoperitoneo. Resultados: Laparotomía de urgencia, corroborando los hallazgos tomográficos y resolviéndose satisfactoriamente con la colecistectomía. Discusión: El diagnóstico de colecistitis hemorrágica es difícil ya que sus manifestaciones clínicas de inicio no difieren de la colecistitis aguda, por lo que la sospecha clínica y el adecuado estudio de imagen son importantes para su detección. Conclusión: A pesar que la colecistitis hemorrágica con perforación y hemoperitoneo es una patología muy poco común, de diagnóstico confuso, es importante establecer la realización de una tomografía computarizada abdominal con contraste endovenoso en pacientes con sospecha de colecistitis aguda grave.

Introduction: Hemorrhagic cholecystitis is a rare complication of acute cholecystitis with a high mortality. Materials and Method: Patient with abdominal pain in right hypochondrium and jaundice. Laboratory analyses and hepatobiliary ultrasound suggested acute cholecystitis, however, general worsening during hospital stay was observed and a computed tomography was performed, revealing hemorrhagic cholecystitis and hemoperitoneum. Results: Urgent laparotomy which confirmed tomographic results, successfully solved with cholecystectomy. Discussion: Hemorrhagic cholecystitis diagnosis is difficult as symptoms at the beginning do not differ from acute cholecystitis, then, clinical suspicion and a correct image analysis is crucial for its detection. Conclusion: Although, perforated hemorrhagic cholecystitis with hemoperitoneum is a very rare entity with confused diagnosis, an abdominal computed tomography with intravenous contrast is very important in any patient with severe acute cholecystitis suspicion.

Assuntos

RESUMO

Cases of intra-abdominal foreign bodies are rare and caused mainly by retained elements after surgery and by, in general, accidental swallowing and subsequent perforation of the gastrointestinal tract. We report the case of a 74 year-old female patient, presenting with fever, abdominal pain and weight loss. An abdominal TC showed the presence of a foreign body that had caused a perforation of duodenum and gallbladder neck; surgery showed that it was a 4 cm ‘twist-tie’. The description of the case presents differential diagnoses, based on a review of the literature. This is a rare event and corresponds to the third publication of a case of a twist-tie intra-abdominal foreign body, according to a review of other medical publications.

Los cuerpos extraños intraabdominales son infrecuentes y se deben en gran medida a accidentes quirúrgicos y a ingesta, en general, accidental y posterior perforación del tracto digestivo. Se reporta un caso de una mujer de 74 años con fiebre, dolor abdominal y baja de peso, cuyo estudio mediante tomografía computada de abdomen muestra un cuerpo extraño que perfora duodeno y el bacinete. La cirugía demostró que se trataba de un “twist tie” de 4 cm que perforaba esas estructuras. En la descripción del caso se plantean los diagnósticos diferenciales basados en revisión de la literatura. Se presenta este caso por ser muy infrecuente, correspondiendo a la tercera publicación de un cuerpo extraño intra-abdominal por twist tie, de acuerdo con la revisión de las publicaciones médicas.

Assuntos

RESUMO

Objetivo: Conocer la prevalencia e identificar cuáles datos clínicos y/o bioquímicos detectan la perforación vesicular en forma preoperatoria en pacientes con colecistitis aguda. Sede: Hospital General de México, O.D. Diseño: Estudio de casos y controles. Análisis estadístico: Razón de momios, Chi cuadrada (χ²) y t de Student. Material y métodos: Se estudiaron los expedientes de pacientes operados por el servicio de urgencias del Hospital General de México en el periodo de diciembre 2007 a septiembre del 2009. Se revisaron todos los pacientes operados de colecistectomía, seleccionando, de éstos, a los pacientes con reporte de perforación de vesícula biliar (correspondiendo a casos) y se comparó con controles pareados (una perforación por dos no perforados), es decir, pacientes con las mismas características pero sin perforación vesicular. La variables analizadas fueron edad, género, tipo de perforación, signo de Murphy, signos de irritación peritoneal, fiebre, comorbilidades, consumo de tabaco, alcohol o drogas, tiempo de evolución, de ingreso a quirófano, diagnóstico preoperatorio clínico y paraclínico, tipo de abordaje, sitio de perforación, complicaciones y mortalidad. Resultados: Las comparaciones entre cada una de las variables estudiadas y la presencia o no de perforación indica la fiebre (temperatura > 38°C) antes de cirugía como único factor con significancia estadística RM de 1.15 (IC 95% de 0.51 a 2.6) P = 0.001. Conclusiones: La prevalencia de perforación de vesícula biliar en pacientes con colecistitis aguda es de 9.7%. El único dato clínico relacionado a esta complicación y que pudiera hacer sospechar su diagnostico es la fiebre.

Objective: To know the prevalence and to identify which clinical and/or biochemical data can lead to detect gallbladder perforation preoperatively in patients with acute cholecystitis. Setting: General Hospital of Mexico City (Ministry of Health). Design: Study of cases and controls. Statistical analysis: Odds ratio, Chi square (χ²), and Student's t test. Material and methods: We examined the clinical files of patients operated at the Emergency Ward of the General Hospital of Mexico City in the period between December 2007 and September 2009. We reviewed all patients subjected to cholecystectomy, choosing from them those patients with perforation of the gallbladder (cases) and compared them with paired controls (one perforation with two non-perforated), that is, patients of the same characteristics but without gallbladder perforation. Analyzed variables were age, gender, type of perforation, Murphy's sign, sign of peritoneal irritation, fever, comorbidities, alcohol or drug consumption, smoking, time of evolution, time of operating room admittance, clinical and paraclinical preoperative diagnosis, type of approach, perforation site, complications, and mortality. Results: Comparison between each studied variable and the presence or not of perforation reveals fever (temperature > 38°C) as the sole factor with statistical significance, odds ratio of 1.15 (IC 95% from 0.51 to 2.6) P = 0.001. Conclusions: Prevalence of gallbladder perforation in patients with acute cholecystitis is of 9.7%. The only clinical data related to this complication and that could lead to suspect its diagnosis was fever.