Incidentally Detected Residual Gallbladder Calculi by Computed Tomography in Acute Pancreatitis. Case Report
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SURGERY
Incidentally Detected Residual Gallbladder Calculi by Computed Tomography in Acute Pancreatitis. Case Report Narendra Pandit 1
&
Gajendra Prasad Das 1 & Karun Devkota 2 & Laligen Awale 1
Accepted: 6 August 2020 / Published online: 10 August 2020 # Springer Nature Switzerland AG 2020
Abstract Calculi in the gallbladder or cystic duct remnant account for 0.3 to 2.5% of cases of post-cholecystectomy syndrome and must be considered in any patient who has undergone “difficult” cholecystectomy. We present an interesting case of a 62-year-old male, diagnosed to have moderately severe acute biliary pancreatitis, 4 years past laparoscopic converted to open cholecystectomy (LCOC). On evaluation with contrast computed tomography (CT) of the abdomen, changes of acute pancreatitis, along with a remnant gallbladder containing radiopaque calculi, were identified. The patient subsequently was managed successfully with completion cholecystectomy with common bile duct (CBD) exploration and T-tube drainage (for CBD calculi). Hence, differential diagnosis of residual gallbladder calculi (although rare) should be kept in a patient with acute biliary pancreatitis, following LCOC for a “difficult” gallbladder. Keywords Gallbladder remnant . Calculi . Difficult cholecystectomy . Pancreatitis
Introduction Laparoscopic cholecystectomy is one of the most commonly performed procedures worldwide. It has accomplished laparoscopically in 90 to 97% of cases, while the remaining group of “difficult” cholecystectomy requires open conversion [1]. The difficult gallbladder is a scenario caused by the inflammation, difficult exposure, Mirizzi syndrome, and cirrhosis of the liver. These are the situations where the surgeons often adapt the “bail-out” strategy such as subtotal This article is part of the Topical Collection on Surgery * Narendra Pandit [email protected] Gajendra Prasad Das [email protected] Karun Devkota [email protected] Laligen Awale [email protected] 1
Surgical Gastroenterology Division, Department of Surgery, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
2
Department of Radiodiagnosis, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
cholecystectomy (3–8% of total cholecystectomies), so as to avoid iatrogenic complications to the bile duct and bowel [2]. On the contrary, the subtotal cholecystectomy does have the risk of increased bile leak from the stump and rarely a residual gallbladder (GB) [3]. These residual GB and the cystic duct can harbor calculi and lead to a “post-cholecystectomy syndrome” [4]. We, herein, report a rare presentation of residual GB calculi presenting with acute pancreatitis following a difficult cholecystectomy.
Case Report A 62-year-old male presented to the emergency department with a 2-day history of severe epigastric pain in the abdomen, associated with nausea and vomiting. The patient’s past history was significant for difficult cholecystectomy converted to open 4 years back. On general examination, his pulse was 110 beat
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