• Journal of Yeungnam Medical Science
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• v.23 no.2
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• pp.152-161
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• 2006

Carcinoma of the gallbladder is an uncommon but highly malignant tumor with a poor five year survival rate. Early detection is very important for successful treatment because this tumor is very hard to cure in cases where it has advanced beyond the reach of surgical treatment. The purpose of this review was to evaluate risk factors for carcinoma of the gallbladder and determine the best management approach.. Solitary polys, more than one cm are considered to be predisposing factors for gallbladder carcinoma when they are found to be echopenic, sessile, and with a high cell density. Anomalous union of the pacreato-biliary duct(AUPBD) without a choledochal cyst is also considered to increase risk for gallbladder carcinoma. A polyps size of more than one cm and an AUPBD are indications for prophylactic cholecystectomy. The presence of gallstones is a well-established risk factor for the development of gallbladder carcinoma; risk appears to correlate with the stone size and the duration of chronic cholecystitis. Metaplastic changes of the gallbladder epithelium present with chronic cholecystitis and may indicate a premalignant lesion. Abnormal forms of cholecystitis such as xanthogranulomatous or a porcelain gallbladder also have malignant potential; cholecystoenteric fistula as well as bacterial infection of the gallbladder(typhoid, helicobacter species) also has malignant potential. In this review, the risk factors associated with carcinoma of the gallbladder are summarized with special attention to gallstones, polyps, AUPBD, and chronic inflammation.

• Journal of Yeungnam Medical Science
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• v.32 no.1
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• pp.60-64
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• 2015

A choledochocele is an expanded sac of the duodenal side of the distal common bile duct (CBD), and is categorized as a type III choledochal cyst. Unlike other choledochal cysts, it can be easily overlooked because of its very low prevalence, non-specific clinical symptoms, and lack of distinctive radiological findings. However, a patient having a repeated pancreaticobiliary disorder with an unknown origin, frequent abdominal pain after cholecystectomy, or repeated non-specific gastrointestinal symptoms can be suspected as having a choledochocele, and a more accurate diagnosis can be achieved via endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound. Because it rarely becomes malignant, a choledochocele can be treated via endoscopic sphincterotomy (EST) and surgical treatment. The authors were able to diagnose choledochocele accompanied by a stone in a patient admitted to the authors' hospital due to cholangitis and pancreatitis. The patient's condition was suspected to have been caused by a distal CBD stone detected via multiple detector computed tomography and ERCP, and was successfully treated via EST.

• Journal of Veterinary Clinics
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• v.27 no.5
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• pp.605-609
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• 2010

A 10-year-old spayed female Yorkshire terrier presented with vomiting, and anorexia. Obstructive choledocholith with concurrent pancreatitis and hepatorenal syndrome was diagnosed based on analyses of the blood profiles, abdominal radiographs, ultrasonography and CT. Choledoliths were removed from the common bile duct, yet the patient died suddenly 10 days after surgery. Recurrent choledolithiasis has not been reported in a cholecystectomized dog and this report focuses on the imaging features of ultrasonography and CT of recurrent choledoliths.

• Journal of Yeungnam Medical Science
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• v.2 no.1
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• pp.39-44
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• 1985

To assess the effect of post-operative pain control of upper abdominal surgery through lumbar epidural narcotic injection, the 3rd or 4th lumbar epidural puncture was done, and were injected 1mg, of morphine (Group I) or 10mg, of demerol (Group II) mixed with 10ml of normal saline into the epidural space, after operation of the cholecystectomy in 10patients and antrectomy and vagotomy, subtotal or total gastrectomy in 10patients. Time interval of the post-operative analgesic effect between morphine and demerol groups were compared. The results of this study were as follows: 1. In the group I, average analgesic duration was 29.4 hours. 2. In the group II, average analgesic duration was 4.0 hours. It is concluded that post-operative pain control of upper abdominal surgery through the lumbar epidural narcotic injection was effective, and morphine injection was more effective than demerol.

• Korean Journal of Community Nutrition
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• v.13 no.2
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• pp.288-297
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• 2008

It has been reported frequently that clinical features of gallstone disease in Korean were similarly changing to those of Occidentals. This changing was thought to be due to Westernized lifestyle and dietary patterns in Korean. The purpose of this study was to investigate the nutritional risk factor among patients with gallstone. The subjects of this study were 90 gallstone group with biliary stone as confirmed by cholecystectomy and 111 control group with no biliary stone as confirmed by ultrasonography adjusted according to age and gender. Anthropometric indices and biomarkers were measured and dietary habit as well as nutrient consumption pattern were investigated using a structured checklist of health-related eating behavior and a semi-quantitative food frequency questionnaire. The mean age was higher in GG (gallbladder stone patient group) than CG (control group). The average BMI and WHR (waisthip ratio) tended to be higher than those in CG. WC (waist circumference) and WHR of women in GG were significantly higher than in CG. GG had lower levels in TC (p < 0.01), LDL-C (p < 0.05), and HDL-C (p < 0.05), but higher FBG levels (p < 0.001). GG tended to be associated with lower physical activity and more frequent consumption of meat, meats with high fat and high sugar content food. The consumption levels of fiber (p < 0.05), vitamin C (p < 0.05), calcium (p < 0.01) in GG were significantly lower than in CG. These findings showed that the association with incidence of gallbladder stone and anthrophometric indices and dietary consumption patterns. Further study may be necessary to elucidate the dietary risk factors in the changing patterns of gallstone disease.

• Journal of Yeungnam Medical Science
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• v.7 no.1
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• pp.165-171
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• 1990

Human Fasciola hepatica infection is a rare entity involving infestation of the liver and biliary tree with adult flukes. which can result in hepatitis. cirrhos is and biliary tract inflammation. obstruction and lithiasis. The patient had the typical diagnostic tetrad of fever. eosinophilic leukocytos is. tender hepatomegaly and fluke ova in the stools. Theatment consistes of Emetine hydrochloride administration for hepatic involvement and common bile duct exploration for removal of flukes. with cholecystectomy for associated cholelithiasis. The combination of medical and surgical therapy cal be expected to produce an arrest of this infection. The removed liver revealed eggs of the fasciols species in the intrahepatic bile duct. The clinical history. pathological findings and treatment of this case were described.

• The Korean Journal of Gastroenterology
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• v.72 no.6
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• pp.318-321
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• 2018

Primary neuroendocrine tumors originating from the extrahepatic bile duct are rare. Among these tumors, large cell neuroendocrine carcinomas (NECs) are extremely rare. A 59-year-old man was admitted to Sanggye Paik Hospital with jaundice that started 10 days previously. He had a history of laparoscopic cholecystectomy, which he had undergone 12 years previously due to chronic calculous cholecystitis. Laboratory data showed abnormally elevated levels of total bilirubin 15.3 mg/dL (normal 0.2-1.2 mg/dL), AST 200 IU (normal 0-40 IU), ALT 390 IU (normal 0-40 IU), and gamma-glutamyl transferase 1,288 U/L (normal 0-60 U/L). Serum CEA was normal, but CA 19-9 was elevated 5,863 U/mL (normal 0-37 U/mL). Abdominal CT revealed a 4.5 cm sized mass involving the common bile duct and liver hilum and dilatation of both intrahepatic ducts. Percutaneous transhepatic drainage in the left hepatic duct was performed for preoperative biliary drainage. The patient underwent radical common bile duct and Roux-en-Y hepaticojejunostomy for histopathological diagnosis and surgical excision. On histopathological examination, the tumor exhibited large cell NEC (mitotic index >20/10 high-power field, Ki-67 index >20%, CD56 [+], synaptophysin [+], chromogranin [+]). Adjuvant concurrent chemotherapy and radiotherapy were started because the tumor had invaded the proximal resection margin. No recurrence was detected at 10 months by follow-up CT.

• The Journal of Internal Korean Medicine
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• v.43 no.3
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• pp.477-484
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• 2022

Objective: The purpose of this study was to report the improvement effect of symptoms of integrative cancer treatment (ICT) on recurrent gallbladder cancer patients. Methods: A 73-year-old patient with recurrent gallbladder cancer visited the Daejeon Korean Medicine Hospital of Daejeon University East West Cancer Center (EWCC) on February 2022. After the diagnosis of gallbladder cancer, the patient underwent cholecystectomy and relapsed during follow-up. After the operation, the cancer recurred during follow-up, and after radiation treatment, she had been receiving ICT since February 2022. The clinical outcomes were measured by X-ray, computed tomography (CT), laboratory findings, including tumor markers (CEA, CA19-9), and numeric rating scales (NRS). Results: After treatment, abdominal pain was relieved from NRS 5 to 2, and abdominal circumference decreased from 74.5 to 67. During and after treatment, we found neither hepatotoxicity nor nephrotoxicity in the laboratory findings. Conclusion: This case study suggests that ICT may improve symptoms in patients with gallbladder cancer.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.3
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• pp.277-286
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• 2023

Backgrounds/Aims: To study histopathological changes in gall bladder mucosa in cholelithiasis patients, and analyse their relation to the number and size of gallstones. These findings were evaluated in the context of age distribution of the study population. Methods: One hundred cases of cholecystectomy were part of the study, which was conducted in collaboration with the pathology department. The time period of the study was January 2020 to June 2021. Results: Maximum cases had multiple stones (69.0%), while one third cases (31.0%) had solitary stones. While initial univariate analysis showed age (odds ratio [OR], 6.882; p = 0.043), gallstone number (OR, 9.1; p = 0.050), gallstone size (OR, 17.111; p = 0.013), and duration of symptom (OR, 34.125; p = 0.001) to be significant risk factors associated with gallbladder carcinoma, multivariate analysis found none of these variables to be significant. However, conditional multivariate analysis for the duration of symptom (p = 0.008; OR, 21.118) yielded significant p-value. With histopathological diagnoses, 5% of cases had gallbladder cancer. Conclusions: This study shed light on the rising incidence of cholelithiasis in the young population and the high rate of gallbladder carcinoma in Punjab, India. Although gall stone characteristics (size, number) and patient age appeared to be significant risk factors when their individual relation with gallbladder carcinoma was studied, multivariate analysis, could not prove that. Conditional multivariate analysis showed the duration of symptom to be the only significant risk factor associated with gallbladder carcinoma. Further research with larger sample size is needed to study the rising incidence of gallbladder carcinoma, and the risk factors associated with it.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.3
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• pp.322-327
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• 2023

Situs inversus totalis (SIT) is a rare condition in which cardiac and abdominal organs are inverted from their normal left-sided orientation. Mirizzi syndrome, characterized by the obstruction of the common hepatic duct or the common bile duct by gallstone, is a rare condition. Mirizzi syndrome co-occurrence in SIT patients is rare. Gallbladder in sinistroposition is extremely uncommon in SIT patients. We report a known case of diabetes, ventricular septal defect with transposition of the great arteries in a 32-year-old female who presented with jaundice, cholangitis, chills, and fever that had lasted for 10 days. She was confirmed to have SIT with type III Mirizzi syndrome following a series of diagnostic procedures. Primarily, endoscopic retrograde cholangiopancreatography along with common bile duct stenting was performed to initially reduce cholangitis. After an eight-week follow-up after the reduction of cholangitis, surgery was conducted. Mirror-imaged ports were used for the laparoscopic procedure, and the surgeon was on the patient's right side rather than the usual left side. The patient was discharged from the hospital following two days of uneventful healing.