Perfidious gallbladders - a diagnostic dilemma with XXXX .

@entity1 @entity3883 @entity1157 @entity13082 @entity2679 @entity1086
INTRODUCTION: @entity13082 ( @entity13082 ) is an uncommon variant of chronic @entity2679 characterised by marked thickening of the gallbladder wall and dense local adhesions. Pre-operative and intra-operative diagnosis is difficult and it often mimics a @entity1086 ( @entity1086 ). Laparoscopic cholecystectomy (LC) is frequently unsuccessful with a high conversion rate. A series of @entity1 with this condition led us to review our experience with @entity13082 and to try to develop a care pathway for its management. @entity1 AND METHODS: A retrospective review of the medical records of 1296 consecutive @entity1 who had undergone cholecystectomy between January 2000 and April 2005 at our hospital was performed. Twenty-nine cases of @entity13082 were identified among these cholecystectomies. The clinical, radiological and operative details of these @entity1 have been analysed. RESULTS: The incidence of @entity13082 was 2.2% in our study. The mean age at presentation was 60.3 years with a female:male ratio of 1.4:1. Twenty-three @entity1 (79%) required an emergency surgical admission at first presentation. In three @entity1 , a @entity1086 was suspected both radiologically and at operation (10.3%), but was later disproved on histology. Seventeen @entity1 (59%) had @entity3883 at first presentation and required an endoscopic retrograde cholangiopancreatography (ERCP) before LC. Of these, five had common bile duct stones. Abdominal ultrasound scan showed marked thickening of the gallbladder wall in 16 cases (55%). LC was attempted in 24 @entity1 , but required conversion to an open procedure in 11 @entity1 (46% conversion rate). A total cholecystectomy was possible in 18 @entity1 and a partial cholecystectomy was the choice in 11 (38%). The average operative time was 96 min. Three @entity1 developed a postoperative @entity1157 , one of whom required ERCP and placement of a biliary stent. The average length of stay in the hospital was 6.3 days. CONCLUSIONS: Severe @entity13082 often mimics a @entity1086 . Currently, a correct pre-operative diagnosis is rarely made. With increased awareness and a high index of suspicion, radiological diagnosis is possible. Preoperative counselling of these @entity1 should include possible intra-operative difficulties and the differential diagnosis of @entity1086 . Laparoscopic cholecystectomy is frequently unsuccessful and a partial cholecystectomy is often the procedure of choice.
