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Clin J Gastroenterol 2021 Jun 11. Epub 2021 Jun 11.

Consultant Upper GI Surgeon, North Cumbria University Hospitals NHS Trust, Carlisle, UK.

Biliary hyperkinesia is typically diagnosed in patients with biliary-like pain and no evidence of gall stones on imaging modalities but who have had biliary scintigraphy scan (HIDA) that shows ejection fraction ≥ 80%. This study aims to identify whether the removal of the gall bladder can alleviate the symptoms associated with biliary hyperkinesia. Systematic search following PRISMA guidelines was done from inception to January 2020 using PubMed/Medline, OVID, Embase, Cochrane database of systemic reviews, Cochrane central register of controlled trials, The Database of Abstracts of Reviews of Effects (DARE) and Cochrane library databases. Read More

BMC Vet Res 2021 Jun 10;17(1):215. Epub 2021 Jun 10.

University College Dublin, Belfield, Dublin 4, D04W6F6, Ireland.

Background: The popularity of new world camelids, particularly alpacas, is growing rapidly in Ireland, presenting a clinical challenge to veterinary practitioners who may not have worked with these species previously. To the authors' knowledge, the clinical course of a case of acute fasciolosis in an alpaca has not previously been reported, and fasciolosis has not been reported at all in alpacas in Ireland, making this case report a valuable addition to the current literature.

Case Presentation: A three-year-old male castrated huacaya alpaca was admitted to UCD Veterinary Hospital with a two-day history of colic and tenesmus. Read More

Surg Endosc 2021 Jun 8. Epub 2021 Jun 8.

Department of Gastroenterology, Faculty of Medicine in the Galilee, Galilee Medical Center, Bar-Ilan University, Safed, Israel.

Background: Choledocholithiasis is a commonly encountered disease that is associated with various clinical presentations ranging from mild form of biliary colic to severe life-threatening acute cholangitis. Recently, peri-ampullary diverticulum (PAD) has been linked to the development of biliary diseases; however, data regarding its association with the development of acute cholangitis in the setting of choledocholithiasis are scarce.

Aims: We aimed to identify predictors, specifically PAD, for the development of acute cholangitis in patients with choledocholithiasis. Read More

Front Surg 2021 13;8:643077. Epub 2021 May 13.

Regional Hepato-Pancreato-Biliary Service, Manchester Royal Infirmary, Manchester, United Kingdom.

Index admission laparoscopic cholecystectomy is the standard of care for patients admitted to hospital with symptomatic acute cholecystitis. The same standard applies to patients suffering with mild acute biliary pancreatitis. Operating theatre capacity can be a significant constraint to same admission surgery. Read More

Int J Surg Case Rep 2021 May 13;83:105976. Epub 2021 May 13.

Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, Cuneo, Italy.

Introduction: Limy bile syndrome (LBS) is an unusual condition in which gallbladder and/or bile ducts are filled with paste-like radiopaque material with a high calcium carbonate content. It can be rarely associated with PTH disorder and hypercalcemia.

Presentation Of Case: A 35-year-old woman presented with epigastric and right hypochondrium pain since a few hours. Read More

Gastroenterol Hepatol 2021 May 20. Epub 2021 May 20.

Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Terrrassa, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain. Electronic address:

Introduction: Endoscopic ultrasound (EUS) is a more sensitive technique than transabdominal ultrasound for the diagnosis of gallstones. This greater sensitivity, especially in the diagnosis of microlithiasis/biliary sludge, facilitates the indication of cholecystectomy in patients with symptoms of probable biliary origin but may result in over-indication of this surgery.

Objectives: Evaluate the role of EUS in the diagnosis of minilithiasis/biliary sludge in patients with digestive symptoms of probable biliary origin by resolving the symptoms after cholecystectomy. Read More

Int J Surg Protoc 2021 Apr 27;25(1):61-65. Epub 2021 Apr 27.

Department of Surgery, Gaston Berger University of Saint-Louis, Senegal.

Introduction: Gallstone disease is a disorder characterised by the formation of stones in the biliary tract. It is the most common biliary condition accounting for more than 98% of all gallbladder and biliary tract disorders. In Africa, previous studies have shown a relative rarity of this condition with a prevalence less than 5%; since it is between 2 and 5 times higher in other continents. Read More

Pediatr Surg Int 2021 May 11. Epub 2021 May 11.

Ochsner Clinic Foundation, 1514 Jefferson Hwy, New Orleans, LA, 70121, USA.

Background: Biliary dyskinesia (BD) is a well-established gallbladder pathology in adult patients and rates of cholecystectomy for BD continue to rise in the United States. Many pediatric patients with vague abdominal pain of variable duration are evaluated for biliary dyskinesia. It remains unknown which cohort of pediatric patients diagnosed with BD are most likely to have sustained improvement in symptoms following laparoscopic cholecystectomy. Read More

World J Clin Cases 2021 May;9(13):3038-3047

Department of Medicine, University of Illinois-Peoria, Peoria, IL 61604, United States.

Background: Gallstone pancreatitis is one of the most common causes of acute pancreatitis. Cholecystectomy remains the definitive treatment of choice to prevent recurrence. The rate of early cholecystectomies during index admission remains low due to perceived increased risk of complications. Read More

Clin Endosc 2021 May 4. Epub 2021 May 4.

Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.

Common bile duct (CBD) stones are prevalent in 11% to 21% of patients with gallstones and can cause various clinical manifestations, from biliary colic to biliary sepsis. The treatment of choice is endoscopic retrograde cholangiopancreatography, but approximately 5% to 10% of CBD stones are difficult to remove using these conventional endoscopic methods. Although percutaneous transhepatic cholangioscopy and lithotripsy can be used as an alternative, it can be technically demanding and risky if the intrahepatic duct is not dilated. Read More

Radiographics 2021 May-Jun;41(3):802-813

From the Departments of Radiology (A.P., J.G.F., S.K.V., J.L.F., A.R.K.) and Gastroenterology (A.C.S.), Mayo Clinic, 200 First St SW, Rochester MN 55905.

Hemobilia, or hemorrhage within the biliary system, is an uncommon form of upper gastrointestinal (GI) bleeding that presents unique diagnostic and therapeutic challenges. Most cases are the result of iatrogenic trauma, although accidental trauma and a variety of inflammatory, infectious, and neoplastic processes have also been implicated. Timely diagnosis can often be difficult, as the classic triad of upper GI hemorrhage, biliary colic, and jaundice is present in a minority of cases, and there may be considerable delay in the onset of bleeding after the initial injury. Read More

Cureus 2021 Apr 25;13(4):e14676. Epub 2021 Apr 25.

Gastroenterology and Hepatology, University Hospitals of Morecambe Bay National Health Service Foundation Trust, Lancaster, GBR.

Gallbladder duplication refers to the splitting of "gallbladder primordium" during the early embryonic development in the fifth or early sixth week. Although it is a very rare congenital abnormality and most of the patients will be asymptomatic, yet the symptomatic cases present with abdominal complaints like nausea vomiting, abdominal pain leads to cholecystitis, cholangitis, biliary colic, or pancreatitis. Herein, we present a case report of duplication of the gallbladder, which was difficult to diagnose on radiology. Read More

J Minim Access Surg 2021 Apr 16. Epub 2021 Apr 16.

Department of General Surgery, William Harvey Hospital, Ashford, Kent, UK.

Background: Despite NICE/AUGIS recommendations, the practice of early laparoscopic cholecystectomy (ELC) has been particularly poor in the UK offered only by 11%-20% surgeons as compared to 33%-67% internationally, possibly due to financial constraints, logistical difficulties and shortage of expertise, thus, reflecting the varied provision of emergency general surgical care. To assess whether emergency general surgeons (EGS) could provide a 'Hot Gall Bladder Service' (HGS) with an acceptable outcome.

Patients And Methods: This was a prospective HGS observational study that was protocol driven with strict inclusion/exclusion criteria and secure online data collection in a district general hospital between July 2018 and June 2019. Read More

Am J Case Rep 2021 Apr 19;22:e929150. Epub 2021 Apr 19.

Department of General Surgery, Ascension Michigan Genesys Hospital, Grand Blanc, MI, USA.

BACKGROUND Abnormal communicating channels or fistulas between the gallbladder or common bile duct and the intestine are rare, but have potential to result in serious complications. Further complications can arise with migration of gallstones from the gallbladder to the intestines, causing distal obstruction in the ileum, intestinal hemorrhage, or intestinal perforation. High clinical suspicion is warranted for the diagnosis of Bouveret's syndrome, with anticipation of surgery to prevent distal gallstone migration that would otherwise result in unfavorable patient outcomes. Read More

J Clin Neurosci 2021 May 11;87:66-68. Epub 2021 Mar 11.

Department of Neurosurgery, Christchurch Hospital, 2 Riccarton Ave, Christchurch 8011, New Zealand.

Right upper quadrant (RUQ) abdominal pain and discomfort is a common presenting complaint often associated with abdominal pathology. We report a rare presentation of structural intracranial pathology in a patient initially presenting with RUQ abdominal discomfort. While initial investigations concentrating on abdominal causes revealed no likely culprit, progression of symptoms to involve right lower limb weakness eventually prompted the patient's re-presentation and eventual definitive diagnosis. Read More

Pediatr Gastroenterol Hepatol Nutr 2021 Mar 4;24(2):164-172. Epub 2021 Mar 4.

Department of Gastroenterology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey.

Purpose: The use of Endoscopic ultrasonography (EUS) in pediatric patients is not as common as in adults. The aim of this study is to evaluate the role of EUS in the diagnosis of pancreatobiliary disease in childhood.

Methods: Between December 2016 and January 2018, the findings of patients who underwent EUS were evaluated retrospectively. Read More

Case Rep Surg 2021 25;2021:5569850. Epub 2021 Mar 25.

Department of Surgery, Oswego Hospital, New York 13126, USA.

Introduction: Biliary dyskinesia is defined by a gallbladder ejection fraction (EF) of less than 35% on HIDA scan, and these patients have shown a good response to cholecystectomy. Management of patients with biliary colic symptoms who have a hyperkinetic gallbladder (EF > 80%) is not clearly defined. Herein, I report three cases of the symptomatic hyperkinetic gallbladder that were successfully managed with cholecystectomy. Read More

BMJ Case Rep 2021 Mar 24;14(3). Epub 2021 Mar 24.

Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand

Acute cholangitis is a condition of bacterial infection following hepatobiliary tract obstruction, which signifies poor prognosis unless adequately drained. The most common cause of bile duct obstruction is choledocholithiasis, in contrast to parasitic infestation, a rare entity causing acute cholangitis nowadays. Therefore, we reported the case of a 68-year-old Thai man who presented with acute fever, intense right upper quadrant abdominal pain and jaundice for 2 days. Read More

J Med Ultrasound 2020 Oct-Dec;28(4):256-259. Epub 2020 Sep 12.

Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan.

We report a pediatric case of Type 1C choledochal cyst presented as acute biliary colic pain. Choledochal cyst is an abnormal expansion of the biliary tract. The Type 1 choledochal cyst is the cystic dilation of the common bile duct. Read More

Int J Surg Case Rep 2021 Mar 4;80:105612. Epub 2021 Feb 4.

Beaumont, 28050 Grand River Avenue, Farmington Hills, MI, 48336, United States. Electronic address:

Background: Traditional oncologic pattern of spread of breast cancer is metastasis to axillary lymph nodes, lung, liver and bone (Doval et al., 2006 [1]). Here we present a case of unknown synchronous breast cancer in a patient that was revealed on histopathologic assessment following elective cholecystectomy. Read More

BMJ Open 2021 01 17;11(1):e041931. Epub 2021 Jan 17.

Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China

Introduction: Biliary colic (BC) is a severe pain associated with nausea and vomiting, which is the most common symptom among the gallstone population. This protocol proposes a methodology for conducting a systematic review and meta-analysis that aims to assess the benefits and safety of acupuncture in patients with BC.

Methods And Analysis: Clinical trials will be identified through nine databases from inception to December 2020, using Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Allied and Complementary Medicine Database (AMED), CINAHL, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), VIP Database and Wanfang Database. Read More

Cureus 2021 Jan 5;13(1):e12513. Epub 2021 Jan 5.

Emergency Medicine, Imam Abdulrahman Bin Faisal University, King Fahad University Hospital, Dammam, SAU.

Peptic ulcer is a defect in the mucosal layer of the stomach or duodenum that extends into the deeper layers of their walls. Patients with peptic ulcer disease (PUD) may be asymptomatic or have mild abdominal discomfort. It is one of the common etiologies of perforated viscus resulting in secondary peritonitis, a life-threatening condition that carries high risk for morbidity and mortality especially in those who present late to the hospital or due to unrecognized and misdiagnosed perforation. Read More

J Robot Surg 2021 Jan 5. Epub 2021 Jan 5.

Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.

The robotic platform for cholecystectomy has been extensively studied in comparison to its laparoscopic counterpart with acceptable outcomes. However, wide acceptance of a robotic approach to cholecystectomy has been limited by increased operative room (OR) times and substantially higher cost. This is a single-institution retrospective review of Veteran patients presenting for elective laparoscopic (LC) and robotic (RC) cholecystectomies for benign biliary disease at the Dallas VA Medical Center. Read More

Am Surg 2021 Jan 2:3134820952823. Epub 2021 Jan 2.

Department of Surgery, University of Louisville, Louisville, KY, USA.

Background: Safety and efficacy of endoscopic methods in management of biliary colic after cholecystectomy in patients with minimal biliary ductal dilation and no evidence of biliary stones or malignancy have not been clearly demonstrated. This study aimed to assess the efficacy of endoscopic management of such patients.

Methods: The University of Louisville database was queried for patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) for colicky abdominal pain between 1996 and 2016 who had a common bile duct (CBD) diameter of ≤12 mm. Read More

Asian J Endosc Surg 2021 Jan 3. Epub 2021 Jan 3.

Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.

Introduction: Laparoscopic cholecystectomy is a common surgery with a varying difficulty level. Difficult laparoscopic cholecystectomy may be experienced by many surgeons. If difficult procedures are predicted preoperatively, surgeons may be able to plan the surgical approach and treatment accordingly. Read More

Case Rep Surg 2020 16;2020:8883239. Epub 2020 Dec 16.

Department of Surgery, Texas Tech University Health Sciences Center, Amarillo, TX, USA.

Introduction: Gallbladder agenesis (GA) is a rare congenital malformation, and majority are asymptomatic; however, symptomatic patients present with a clinical picture similar to biliary colic. Work up usually shows contracted gallbladder (GB) on ultrasound (US), and HIDA scan shows nonvisualization. Magnetic resonance cholangiopancreatography (MRCP) can be helpful in the diagnosis; however, the diagnosis without the latter can only be established intraoperatively. Read More

Int J Surg Case Rep 2021 Jan 16;78:223-227. Epub 2020 Dec 16.

Department of General Surgery, The Prince Charles Hospital, Chermside, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Herston, Brisbane, Queensland, Australia. Electronic address:

Introduction: Acute severe cholecystitis with empyema presenting as a gallbladder mass, jaundice and Mirizzi Syndrome (MS) is a complex surgical problem both diagnostically and in terms of management as it mimics both xanthogranulomatous cholecystitis (XGC) and gallbladder carcinoma.

Presentation Of Case: A 48-year-old gentleman was referred to us with biliary colic and weight loss with ultrasound findings of gallstones. At subsequent follow-up he became deeply jaundiced with deranged liver function and a CT showing a gallbladder mass and dilated biliary tree. Read More

Int J Surg Case Rep 2021 Jan 23;78:116-119. Epub 2020 Nov 23.

Faculty of Medicine, Cairo University, Kasr Alainy St., Cairo, 11562, Egypt. Electronic address:

Introduction: Abnormal anatomy of the biliary tree predisposes patients to higher risks of ductal injury and postoperative complications. One of the extremely rare abnormalities of the cystic duct is the duplication of the cystic duct with a single gallbladder. The diagnosis is usually established during surgery. Read More

Surgery 2021 May 13;169(5):1086-1092. Epub 2020 Dec 13.

Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA. Electronic address:

Background: A minimally invasive step-up approach to necrotizing biliary pancreatitis often requires multiple interventions, delaying cholecystectomy. The risk of gallstone-related complications during this time interval is unknown, as is the feasibility and safety of cholecystectomy after minimally invasive step-up treatment. In this paper, we analyzed both. Read More