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2010, Number 4

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Rev Mex Cir Endoscop 2010; 11 (4)

Laparoscopic cholecystectomy due to cholecystitis with empyema in patients scoring C according to Child-Pugh Score. Myth or reality?

De la Peña MS, Ramírez CG, Liho NA

Language: Spanish
References: 18
Page: 213-217
PDF size: 79.55 Kb.


ABSTRACT

Introduction: The frequency of diseases of gallbladder and bile ducts is higher in patients with liver cirrhosis than in the general population, due to hypersplenism, elevated estrogen levels, and increased intravascular hemolysis. Mortality in these patients is high, so the cholecystostomy is indicated as a alternative treatment. Case report: Male 46 years old, alcohol intake since 15 years todrunkenness, for periods of 20 days. Start with malaise, vomiting, melena, hematemesis, epigastric pain, Glasgow 11, hepatic encephalopathy III, fever. Ultrasound report: gallbladder with double wall. Labs: WBC 38,000, bandemia, neutrophilia, platelets 76,000, BT 6.9 mg/dL, BD 2.36 mg/dL, creatinine 5.1 mg/dL, BUN 113.7 mg/dL, urea 243.3 mg/dL. PT 21.3, INR1.8, PTT46.9. Laparoscopic cholecystostomy was performed. Discussion: The complicated gallstones in cirrhotic patients carries high postoperative and transoperative risks by alteration of liver parenchyma. The decision to perform cholecystostomy is based on surgical findings, and the coagulations disorders in Child C patients, the objective of this procedure in the patient was only deal with the emergency surgery that involves a piocolecisto. Conclusion: The surgical findings lead to the implementation of laparoscopic cholecystostomy thus reducing the morbidity and mortality, life expectancy and quality allowing for longer life.


REFERENCES

  1. Pérez MA y cols. Colecistectomía subtotal por vía laparoscópica en la enfermedad litiásica vesicular complicada y en el paciente cirrótico. Cirujano General 2008; 30:.

  2. Bautista GF y cols. Colecistectomía laparoscópica en pacientes cirróticos. Reporte de 5 casos. Revista Mexicana de Cirugía Endoscópica 2002; 3: 172-174.

  3. Gleeman D, Manias N, Levi D, Ward FC, Silva R. Laparoscopic cholecystectomy in cirrhotic patients. J Am Coll Surg 1998; 187: 400-3.

  4. Almenara R, Hoyuela C. Liver: Laparoscopic cholecystectomy in cirrhotic patients. Br J Surg 1995; 82: 88-94.

  5. Gauravmehta MD. Health maintenance issues in cirrhosis. Med Clin N Am 2009; 93: 901-915.

  6. Flores C y cols. Experiencia en el tratamiento laparoscópico de la colelitiasis del cirrótico. Revista de Especialidad en Enfermedades Digestivas 2005; 97: 648-653.

  7. Butte B y cols. Colecistectomía en cirróticos. Factores asociados a morbilidad y mortalidad. Rev. Chilena de Cirugía 2007; 59:.

  8. Membreño A y cols. Colecistostomía con sonda en colecistitis aguda: La alternativa menospreciada. Revista Médica Hondureña 1988;56:.

  9. Nicholas G, Csikesz, BS et al. Nationwide volume and mortality after elective surgery in cirrhotic patients. J Am Coll Surg 2009; 208:.

  10. Bornman PC, Tereblanche J. Subtotal cholecystectomy: Forthe difficult gallbladder in portal hypertension and cholecystitis. Surgery Rev. Chilena de Cirugía 1985; 59: 1-6.

  11. Moore EE, Kelly GL, Driver T, Eiseman B. Reassessment of simple cholecystostomy. Aren Surg 1979; 114: 515.

  12. Skillings JC, Kumal C, Hinshaw JR. Cholecystostomy: a place in modern biliary surgery? Am J Surg 1980;139: 865.

  13. Pérez MA, Roesh DF, Díaz BF, Martínez FS. Experiencia en colecistectomía laparoscópica en el tratamiento de la enfermedad litiásica biliar en el paciente anciano. Cir Gen 2000; 22: 35-40.

  14. Sang SL et al. EUS-guided transmural cholecystostomy as rescue management for acute cholecystitis in elderly or high-risk patients: a prospective feasibility study. Gastrointestinal Endoscopy 2007; 66:.

  15. Schlenker C, Trotter JF, Shah RJ et al. Endoscopic gallbladder stent placement for treatment of symptomatic cholelithiasis in patients with end-stage liver disease. Gastroenterology 2006; 101: 278-83.

  16. Grau TJ y cols. La colecistitis aguda tratada con colecistostomía y extracción de cálculos bajo anestesia local en el paciente anciano de alto riesgo. 2003; 73: 173-7.

  17. Muilenburg et al. Surgery in the patient with liver disease. Med Clin N Am 2009; 93: 1065-1081.

  18. Pugh RN, Murray LN et al. Transection of the oesophagus for bleeding esophageal varices Br J Surg 1973; 60: 646.




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