UNASSIGNED: Gangrenous cholecystitis is a serious complication of untreated gallbladder inflammation, necessitating immediate intervention. The primary resolution involves cholecystectomy, the surgical removal of the gallbladder.The Billroth II gastrectomy, named after Theodor Billroth, addresses gastric conditions by removing a portion of the stomach and reconnecting the remaining section to the small intestine.Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive procedure that diagnoses and treats bile duct and pancreatic duct disorders, using an endoscope to access the ducts, administer contrast dye, and perform interventions like stone removal and stent placement. It aids in managing conditions such as bile duct stones, strictures, pancreatic tumors, and pancreatitis.
UNASSIGNED: A 25-year-old male with a history of gastric ulcer and Billroth II anastomosis presented with right hypochondrium pain, fever, and vomiting. Examination and imaging indicated gallbladder edema, abscess, and fluid collection. Laparotomy revealed severe adhesions around the gallbladder, which were released, and an abscess was drained. Postsurgery, a biliary fistula was suspected, leading to the proposal of an ERCP procedure. During ERCP, a plastic stent was inserted to aid bile drainage.
UNASSIGNED: Therapeutic ERCP effectively treats biliary exudate, including in patients with Billroth II gastrectomy. Using a side-viewing duodenoscope simplifies accessing Vater\'s papilla. This successful procedure had no complications, such as pancreatitis or bleeding, and the patient remained stable.
UNASSIGNED: ERCP in patients with a prior Billroth II gastrectomy is a risky procedure with potential complications. However, it can be considered as an alternative to avoid additional surgery if performed by experienced specialists with the necessary equipment.

Emphysematous cholecystitis is a potentially life-threatening variant of acute cholecystitis, characterized by the presence of gas in the gallbladder wall/lumen due to the proliferation of gas-producing bacteria. Symptoms include upper right quadrant pain, fever, nausea, and vomiting. Laboratory tests may show nonspecific indications of systemic infection, and radiological assessment, especially CT scanning, is crucial for diagnosis. This case underscores the significance of early diagnosis and intervention in managing emphysematous cholecystitis to prevent serious complications and reduce the higher mortality rate compared to acute cholecystitis.

This case report describes a laparoscopic approach using fluorescence imaging guidance to treat gangrenous cholecystitis with perforation (GCP). A male patient in his early 60s presented with 3 days of right upper abdominal pain. Computed tomography and ultrasonography findings were consistent with a stone incarcerated in the gallbladder neck, GCP, and localized peritonitis. Percutaneous gallbladder drainage was initially performed, followed by laparoscopic cholecystectomy 7 days later, using combined intravenous and intracholecystic fluorescent cholangiography. This technique allowed visualization of the cystic and common bile ducts during surgery and enabled safe removal of the diseased gallbladder. The patient recovered well without complications, and reported no pain or discomfort at a 2-month follow-up.

Gangrenous cholecystitis (GC) is a severe form of acute cholecystitis (AC) with ischemia and necrosis of the gallbladder (GB) wall. Patients with GC are sicker than the usual AC patients, and their surgical treatment is more complex and linked with a higher risk of morbidity and mortality. Typically, the first imaging modality used to assess patients with clinically suspected AC is ultrasound. However, if the ultrasound results were inconclusive, a CT scan might help evaluate these individuals. Our study presents a 62-year-old male who presented with mild right upper quadrant discomfort. However, an abdominal computed tomography CT scan showed a pericholecystic fluid collection with a sign of GB perforation that was managed with subtotal cholecystectomy. Five days after the operation, the patient was discharged to home in excellent condition.

Mucinous ovarian cancer occurs sporadically, with a frequency of approximately 3-5% among all subtypes of ovarian cancer. Extreme leukocytosis >40,000 and 50,000 has been described in most solid tumors and is associated with a poor prognosis, although there is a lack of literal data of its occurrence after cytoreductive surgery and HIPEC in the treatment of advanced mucinous ovarian cancer. There is higher risk of the occurrence of cholecystitis in oncology patients compared to the general population, although there is no formal evidence for this, and the association with ovarian cancer is accompanied by a relative risk of 1.38. Hypercalcemia-hyperleukocytosis is a syndrome associated with head and neck cancers, although, to our knowledge, it has not been described in mucinous ovarian cancer, especially after cytoreductive surgery and HIPEC.

BACKGROUND: The utility of the SAND balloon catheter in laparoscopic cholecystectomy for acute cholecystitis (AC) remains unclear.
METHODS: A retrospective cohort study of patients who underwent emergency cholecystectomy at Shinshu University was performed to evaluate the efficacy of the SAND balloon catheter in cases of AC (SAND balloon utilization: Group S, n = 44; non-utilization: Group non-S, n = 47).
RESULTS: The duration of surgery was significantly shorter in Group S than in Group non-S (p = .031). Despite comparable incidences of blood transfusions in the two groups, intraoperative blood loss was significantly less in Group S than in Group non-S (p = .013). The incidence of postoperative intraperitoneal infection tended to be higher in Group non-S (p = .076). Within Group non-S, bile spillage during operation was found in 16 (34.0%) patients. The multivariate analysis revealed that gangrenous AC was the strongest independent risk factor for bile spillage during operation (odds ratio [OR]: 19.1; 95% confidence interval [CI]: 2.84-78.4; p = .002), followed by surgeons with ≤10 years of experience (OR: 11.3; 95% CI: 1.81-70.6; p < .010).
CONCLUSIONS: Implementation of the SAND balloon catheter in patients with AC is a safe and efficacious surgical option. This catheter is recommended in cases of gangrenous cholecystitis and for surgeons with limited experience.

Acute cholecystitis is the most common presentation of gallbladder (GB) disease. It has an incidence of around 200,000 cases a year in the United States (US) and affects approximately 20 million individuals in the US. In most cases, it presents with a history of symptomatic gallstones. Initial management includes intravenous hydration and antibiotics, bowel rest, and analgesia. Complicated cases are typically resolved with surgery (laparoscopic cholecystectomy). The pathogenesis of acute cholecystitis is most often explained by obstruction of the cystic duct. Research has shown that there are more contributing factors than just obstruction alone. We present a case of a 38-year-old Hispanic woman who came to our emergency department with a chief complaint of the anterior chest wall and epigastric pain. Physical examination was remarkable for epigastric tenderness and negative Murphy\'s sign. She had no fever. Cardiac troponins and electrocardiogram (EKG) were negative. Initial labs showed no sign of infection with white blood cell (WBC) count within the normal range, and only mildly elevated aspartate aminotransferase (AST), alanine transaminase (ALT), and total bilirubin. Follow-up abdominal computerized tomography (CT) scan without contrast and right upper quadrant (RUQ) abdominal ultrasound showed cholelithiasis without evidence of cholecystitis. An hepatobiliary iminodiacetic acid (HIDA) scan on day three of admission revealed an obstruction of the cystic duct. The patient was scheduled for laparoscopic cholecystectomy with an intraoperative cholangiogram. The surgery was uneventful; it was remarkable for a very distended, inflamed, and edematous GB, which had to be decompressed with a lap needle for removal. It is evident that acute cholecystitis may not always present with the classic diagnostic criteria, including laboratory results (leukocytosis, elevated C-reactive protein) and physical exam findings (fever, RUQ pain, and + Murphy\'s sign). However, a thorough work-up can be just as effective in diagnosis.

Gangrenous gallbladder (GGB) is a life-threatening complication of acute cholecystitis, which happens due to gallbladder (GB) wall ischemia and necrosis. Delaying the diagnosis of GGB is life-threatening and may happen in asymptomatic patients. We present a case of an elderly male patient with a history of gastric carcinoid tumor, with partial gastric resection, who presented with generalized weakness and jaundice. His total bilirubin was elevated and an ultrasonography and computed tomography (CT) scan of the abdomen showed evidence of acute cholecystitis. An endoscopic retrograde cholangiopancreatography (ERCP) the day after admission showed no evidence of choledocholithiasis or cholangitis. It was during laparoscopic cholecystectomy three days later that the diagnosis of GGB was made as the GB was found to be necrotic with extensive adhesions. The patient also required intravenous antibiotics prior to discharge. This case illustrates risk factors for the development of gangrenous cholecystitis, physical findings in asymptomatic patients, and the importance of early diagnosis in order to reduce morbidity in this patient population.

UNASSIGNED: Laparoscopic cholecystectomy within one week of acute cholecystitis is considered safe and advantageous. Surgery beyond first week is reserved for non-resolving attack or complications. To compare clinical outcomes of patients undergoing laparoscopic cholecystectomy in the first week and between two to six weeks of an attack of acute cholecystitis.
UNASSIGNED: In an analysis of a prospectively maintained database, all patients who underwent laparoscopic cholecystectomy for acute cholecystitis were divided into two groups: group A, operated within one week; and group B, operated between two to six weeks of an attack. Main variables studied were mean operative time, conversion to open cholecystectomy, morbidity profile, and duration of hospital stay.
UNASSIGNED: A total of 116 patients (74 in group A and 42 in group B) were included. Mean interval between onset of symptoms & surgery was five days (range, 1-7 days) in group A and 12 days (range, 8-20 days) in group B. Operative time and incidence of subtotal cholecystectomy were higher in group B (statistically not significant). Mean postoperative stay was 2 days in group A and 3 days in group B. Laparoscopy was converted to open cholecystectomy in two patients in each group. There was no incidence of biliary injury. One patient in group B died during the postoperative period due to continued sepsis and multiorgan failure.
UNASSIGNED: In tertiary care setting, with adequate surgical expertise, laparoscopic cholecystectomy can be safely performed in patients with acute cholecystitis irrespective of the time of presentation.

Gangrenous cholecystitis is a severe complication of acute cholecystitis. It is often found incidentally during laparoscopic cholecystectomy or during conversion to open surgery and diagnosed with subsequent pathological analysis. While intraoperative diagnosis is typically through direct visualization of the gallbladder, specific diagnostic modalities may guide physicians toward an earlier diagnosis. Surgical intervention and a more aggressive approach are often needed to prevent the advancement of the disease and its catastrophic complications. This case report illustrates the distinct risk factors predisposing a patient to develop gangrenous cholecystitis. Comorbidities such as hypertension, coronary artery disease, age, the relevance of the SIRS criteria, and elevated liver enzymes are explored as predictive factors in a patient with gangrenous cholecystitis.