급성 담낭염의 비수술적 담낭배액술 - 내시경적 경비 담낭배액술 및 경피경간 담낭배액술을 중심으로

봉형근(Hyung Keun Bong),문종호(Jong Ho Moon),이영홍(Young Hong Lee),조영덕(Young Deok Cho),김진오(Jin Oh Kim),조주영(Joo Young Cho),김연수(Yun Soo Kim),이준성(Joon Seong Lee),이문성(Moon Sung Lee),황성규(Seong Gyu Hwang),심찬섭(Chan 대한소화기학회 1998 대한소화기학회지 Vol.30 No.1

N/A Background/Aims: Acute cholecystitis is the most common biliary emergency and until now, the choice of the treatment of this disease is surgical operation. But, the. Mortality and morbidity associated with surgical cholecystostomy in those patients are relatively high. Recently, PTCCD and ENGBD were developed as a useful method of nonsurgical cholecystic drainage in high surgical risk group of acute cholecystitis. The purpose of this study was tn assess the usefulness of nonsurgical cholecystic drainage such as PTCCD and ENCrBD in the patients with acute cholecystitis. Methods: Of 59 patients with acute cholecystitis treated with nonsurgical cholecystic drainage, 47 were calculous cholecystitis and 12 were acalculous cholecystitis. Nonsurgical chole- cystic drainages were successful in all 59 cases: PTCCD in 45 patients, ENGBD in rernaining 14 patients. 39 patients were treated with nonsurgical cholecystic drainages due to high surgical risk. In remaining 20 patients there were cholangiocarcinoma in 5 patients, netastatic heptna in 2, gallstone pancreatitis in 1, advanced gastric cancer in 2, refusal of surgery in 10. Results: The prompt clinical recovery were achieved in 42 patients(93.3%) with PTCCD and cornpletely in all 2 cases with ENGBD. In the group with 35 calculous cholecystitis performed PTCCD, 28 under- went PTCCS-L, 4 elective surgery and 3 died because of the underlying condition, In the group with 10 acalculous cholecystitis performed PTC(D, 8 patients need nr further treatment except drainage and remaining 2 patients underwent elective surgery. Jn the group with 12 calculous cholecystitis treated by ENGBD, 10 underwent elective surgery, l F.SWI. And I gallstone dissolu- tion with MTBE. In 2 acalculous cholecystitis treated by ENGBD, the one patient took no further treatment and the other underwent elective surgery. Complications related to PT( CD occurred in 10 of 45 patients, but there was no mortality re]ated to this procedure. No complications were noted related to ENGBD. Conclusions: We conclude that nonsurgical cholecystic drainage witli ENGBD and PTCCD were safe, effective and useful procedures for the management of acute cholecystitis, especially in high surgical risk group, (Korean J Gastroenterol 1997; 30:81 - 89)

Acute Ischemic Cholecystitis after Transarterial Chemoembolization in Hepatocellular Carcinoma

( Jang Han Jung ),( Se Woo Park ),( Jin Lee ),( Dong Hee Koh ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Conventional transarterial chemoembolization (TACE) has been accepted as an effective treatment mordality for unresectable hepatocellular carcinoma (HCC). However acute complications such as hepatic failure, liver abscess, liver rupture and acute cholecystitis can occur after the procedure. This study is to determine the incidence, risk factors and clinical outcome of acute ischemic cholecystitis after TACE of HCC. Methods: From January 2000 to March 2018, retrospective reviewing of complications following conventional TACE therapy for patients with HCC. Patient demographics, clinical information, procedural data, and management of major complications following TACE therapy were gathered from patients’ medical records. Results: 519 patients with hepatocellular carcinoma underwent 1,274 sessions of TACE using adriamycin and lipiodol. According to the case, the practitioner did not perform embolization using gelfoam. Of the 519 patients who underwent TACE, 8 patients (1.5%) presented with radiological features indicative of acute cholecystitis, which developed within 15 days in 4 patients and within the first month after TACE in 4 patients. Review of the TACE procedures revealed that 4 cases had undergone lobar right hepatic embolization, 3 cases right and left hepatic artery embolization and 4 cases additional gelfoam embolization. 2 of 8 patients required laparoscopic cholecystectomy due to gangrenous cholecystitis and gallbladder perforation, 1 of 8 patients performed endoscopic ultrasonography (EUS) guided duodenocystostomy with stent insertion due to suppurative cholecystitis and remaining 5 patients were managed conservatively and none required surgical or interventional management. There was no death from the cholecystitis which was complication of TACE. Conclusions: Acute ischemic cholecystitis after TACE occur in 1.5% in this study. As is known in other studies, cholecystitis is a complication of right lobe embolization in this study. Especially, the use of gelfoam embolization as well as right lobe embolization showed high risk of developing cholecystitis. Although most studies of cholecystitis after TACE have reported conservative management, urgent cholecystectomy or percutaneous cholecystostomy has been required occasionally. Furthermore, the EUS guided duodenocystostomy is performed recently as a choice of treatment for acute cholecystitis due to TACE.

Incidence of acute cholecystitis underwent cholecystectomy in incident dialysis patients: a nationwide population-based cohort study in Korea

최한림,권순길,Han Joung-Ho,Lee Junsung,강길원,Kang Minseok 대한신장학회 2022 Kidney Research and Clinical Practice Vol.41 No.2

Background: Patients on dialysis have numerous gastrointestinal problems related to uremia, which may represent concealed cholecystitis. We investigated the incidence and risk of acute cholecystitis in dialysis patients and used national health insurance data to identify acute cholecystitis in Korea. Methods: The Korean National Health Insurance Database was used, with excerpted data from the insurance claim of the International Classification of Diseases code of dialysis and acute cholecystitis treated with cholecystectomy. We included all patients who commenced dialysis between 2004 and 2013 and selected the same number of controls via propensity score matching.Results: A total of 59,999 dialysis and control patients were analyzed; of these, 3,940 dialysis patients (6.6%) and 647 controls (1.1%) developed acute cholecystitis. The overall incidence of acute cholecystitis was 8.04-fold higher in dialysis patients than in controls (95% confidence interval, 7.40–8.76). The acute cholecystitis incidence rate (incidence rate ratio, 23.13) was especially high in the oldest group of dialysis patients (aged ≥80 years) compared with that of controls. Dialysis was a significant risk factor for acute cholecystitis (adjusted hazard ratio, 8.94; 95% confidence interval, 8.19–9.76). Acute cholecystitis developed in 3,558 of 54,103 hemodialysis patients (6.6%) and in 382 of 5,896 patients (6.5%) undergoing peritoneal dialysis. Conclusions: Patients undergoing dialysis had a higher incidence and risk of acute cholecystitis than the general population. The possibility of a gallbladder disorder developing in patients with gastrointestinal problems should be considered in the dialysis clinic.

급성 담낭염의 비수술적 담낭배액술 - 내시경적 경비 담낭배액술 및 경피경간 담낭배액술을 중심으로 -

봉형근,문종호,이영홍,조영덕,김진오,조주영,김연수,이준성,이문성 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.30 No.1

Acute Cholecystitis in Elderly Patients after Hip Fracture: a Nationwide Cohort Study

장석용,차용한,문윤수,김상하,김하용,최원식 대한의학회 2019 Journal of Korean medical science Vol.34 No.5

Background: Because acute cholecystitis in elderly hip fracture is not easily distinguishable from other gastrointestinal symptoms and involves atypical clinical behaviors, it may not be diagnosed in the early stage. However, the exact incidences could not be reported. We utilized data from a nationwide claims database and attempted to assess the incidence of acute cholecystitis in elderly hip fracture patients and how cholecystitis affects mortality rates after hip fracture. Methods: Study subjects were from the Korean National Health Insurance Service-Senior cohort. From a population of approximately 5.5 million Korean enrollees > 60 years of age in 2002, a total of 588,147 participants were randomly selected using 10% simple random sampling. The subjects included in this study were those who were over 65 years old and underwent surgery for hip fractures. Results: A total of 15,210 patients were enrolled in the cohort as hip fracture patients. There were 7,888 cases (51.9%) of femoral neck fracture and 7,443 (48.9%) cases of hemiarthroplasty. Thirty-six patients developed acute cholecystitis within 30 days after the index date (30-day cumulative incidence, 0.24%). Four of the 36 acute cholecystitis patients (11.1%) died within 30 days versus 2.92% of patients without acute cholecystitis. In the multivariate-adjusted Poisson regression model, hip fracture patients with incident acute cholecystitis were 4.35 (adjusted risk ratio 4.35; 95% confidence interval, 1.66–11.37; P = 0.003) times more likely to die within 30 days than those without acute cholecystitis. Conclusion: Incidence of acute cholecystitis in elderly patients after hip fracture within 30 days after the index date was 0.24%. Acute cholecystitis in elderly hip fracture patients dramatically increases the 30-day mortality rate by 4.35-fold. Therefore, early disease detection and management are crucial for patients.

Deficiencies of Circulating Mucosal-associated Invariant T Cells and Natural Killer T Cells in Patients with Acute Cholecystitis

김정철,진혜미,조영난,권용수,기승정,박용욱 대한의학회 2015 Journal of Korean medical science Vol.30 No.5

Mucosal-associated invariant T (MAIT) cells and natural killer T (NKT) cells are known to play crucial roles in a variety of diseases, including autoimmunity, infectious diseases, and cancers. However, little is known about the roles of these invariant T cells in acute cholecystitis. The purposes of this study were to examine the levels of MAIT cells and NKT cells in patients with acute cholecystitis and to investigate potential relationships between clinical parameters and these cell levels. Thirty patients with pathologically proven acute cholecystitis and 47 age- and sex-matched healthy controls were enrolled. Disease grades were classified according to the revised Tokyo guidelines (TG13) for the severity assessment for acute cholecystitis. Levels of MAIT and NKT cells in peripheral blood were measured by flow cytometry. Circulating MAIT and NKT cell numbers were significantly lower in acute cholecystitis patients than in healthy controls, and these deficiencies in MAIT cells and NKT cell numbers were associated with aging in acute cholecystitis patients. Notably, a reduction in NKT cell numbers was found to be associated with severe TG13 grade, death, and high blood urea nitrogen levels. The study shows numerical deficiencies of circulating MAIT and NKT cells and age-related decline of these invariant T cells. In addition, NKT cell deficiency was associated with acute cholecystitis severity and outcome. These findings provide an information regarding the monitoring of these changes in circulating MAIT and NKT cell numbers during the course of acute cholecystitis and predicting prognosis.

Risk factors for the clinical course of cholecystitis in patients who undergo cholecystectomy

Sol Lee,Chul-Woon Chung,Kwang Hyun Ko,Sung Won Kwon 한국간담췌외과학회 2011 한국간담췌외과학회지 Vol.15 No.3

Backgrounds/Aims: The aims of this study were to evaluate risk factors for acute cholecystitis that have been previously acknowledged and to evaluate several co-morbidities, such as hypertension, diabetes mellitus, cardiovascular disease, cerebrovascular accident and end-stage renal disease for which the prevalence rate has increased in the elderly. Methods: We retrospectively reviewed 611 patients who underwent laparoscopic or open cholecystectomy for cholecystitis between January 2005 and January 2010. The relationships between the clinical outcomes and the clinico- demographic factors were analyzed by univariate and multivariate analyses. Results: The diagnoses of the 611 patients who underwent laparoscopic cholecystectomy were acute cholecystitis (n=258; 42.2%) and chronic cholecystitis (n=353; 57.8%). Male gender (p<0.000), age >50 (p<0.000), fever (p<0.000), leukocytosis (p<0.000), AST elevation (p=0.009), alkaline phosphatase elevation (p<0.000) and an elevation of total bilirubin (p<0.000) were identified as risk factors for acute cholecystitis. The presence of diabetes mellitus (p=0.002) and hypertension (p=0.019) may be risk factors for acute cholecystitis. Conclusions: For patients with risk factors for acute cholecystitis, early management, that is, early checkup and diagnosis following early cholecystectomy, is recommended before the disease progresses to an acute form of cholecystitis. (Korean J Hepatobiliary Pancreat Surg 2011;15:164-170)

두꺼워진 담낭벽의 칼라도플러 초음파 소견

한상석 대한영상의학회 1996 대한영상의학회지 Vol.35 No.5

Purpose : The thickening of the gallbladder wall is a valuable finding for the diagnosis of cholecystitis, butmay be seen in non-cholecystic disease as well as in acute or chronic cholecystitis. The purpose of this study isto determine the value of color Doppler sonography in differentiating the causes of thickened gallbladder wall.Materials and Methods : Ninety eight patients with thickened gallbladder wall(more than 3mm) which was not due togallbladder cancer were prospectively evaluated with color Doppler sonography. Sixty-six cases, confirmed bypathologic reports and clinical records, were analyzed for correlation between thickened gallbladder wall andcolor flow signal according to the underlying causes. Results : Of the 66 patients, 28 cases were cholecystitisand 38 cases had non-cholecystic causes such as liver cirrhosis, ascites, hepatitis, pancreatitis, renal failure, and hypoalbuminemia. Of the 28 patients with cholecystitis(12 acute, 16 chronic), 23(82%) had color Doppler flowsignals in the thickened gallbladder wall. Of the 38 patients with non-cholecystic causes, eight(21%) had colorDoppler flow signals. There was a statistically significant difference of color Doppler flow signals between thecholecystitis and non-cholecystic groups(p=0.0001). No significant difference of color Doppler flow signals wasfound between cases of acute and chronic cholecystitis. Of the 23 patients with color Doppler flow signals in 28cases of cholecystitis, 18(78.3%) showed a linear pattern and five(21.7%) showed a spotty pattern. Of the eightpatients with color Doppler flow signals in the 38 non-cholecystic cases, four(50%) showed a linear pattern andfour(50%) showed a spotty pattern. In cholecystitis, a linear color Doppler flow signal pattern is a much morefrequent finding than a spotty pattern. Conclusion : Color Doppler sonography is a useful and adequate method fordetermining whether a thickened gallbladder wall is the result of cholecystitis or has non-cholecystic causes.

급성 복잡성 담낭염에서 성공적인 복강경 담낭 절제술을 위한 경피적 담낭 배액술과 수술 적기

김정민(Jung-Min Kim),김강성(Kang-Sung Kim),김곤홍(Kaon-Hong Kim) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.73 No.3

Purpose: Laparoscopic cholecystectomy (LC) has been standard in the treatment of uncomplicated symptomatic gallstone disease, but it has been limited for the management of more complicated cholecystitis because of technical difficulties, high conversion rate and postoperative complication rate. Percutaneous gallbladder drainage (PGBD) could been a feasible option for successful LC in patients with acute complicated cholecystitis. Optimal timing of successful LC in acute complicated cholecystitis have been controversy. Aim of this study is to evaluate clinical usefulness of PGBD and optimal timing of successful LC for acute complicated cholecystitis, which is to determine whether PGBD can reduce the conversion or complication rate and shorten the operative time or postoperative hospital stay and timing of LC. Methods: We retrospectively reviewed the medical records of total 230 patients underwent LC for acute cholecystitis during Jan.1994-March 2005 at DongKang hospital. We divided 2 groups patients into complicated cholecystitis and cholecystitis, Which were subdivided each into PGBD and non-PGBD group by whether PGBD performed and PGBD subdivided into the early LC. Results: Summarized results described above firstly non-PGBD complicated cholecystitis showed higher conversion rate and postoperative complication rate and longer OP. time compared to PGBD group, secondly following PGBD, delayed LC have advantages of lower conversion rate and complication rate and shorter OP. time compared to early LC group. Conclusion: PGBD for LC is safe and effective method to immediate LC in the management of acute complicated cholecystitis. Delayed LC after PGBD would be best option of management for acute complicated cholecystitis.

골절을 동반한 다발성 외상 환자에서 발생한 비결석성 담낭염

김기훈 ( Ki Hoon Kim ),경규혁 ( Kyu Hyouk Kyung ),김진수 ( Jin Su Kim ),김관우 ( Kwan U Kim ),김운원 ( Woon Won Kim ),김지완 ( Ji Wan Kim ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4

Purpose: The purpose of this study is to investigate the incidence of acalculous cholecystitis after multiple trauma with fractures and to analyze the characteristics of cholecystitis. Methods: We performed a retrospective study of multiple trauma patients with fractures between April 2010 and April 2012. Sixty-nine patients were identified, and the average age was 46.8(range: 15-74) years. Data were collected regarding associated injury, injury severity score (ISS), the diagnosis time after trauma, diagnostic tool, and management Results: There were three cases(4.3%) of cholecystitis among the 69 cases, and cholecystitis was diagnosed an average of 20.7(range: 8-33) days after injury. Two patients complained of abdominal pain at diagnosis, but the other patient who had undergone surgery for small bowel perforation at the time of the injury had no abdominal pain. All three patients had abnormal liver function tests (LFTs) at diagnosis. The cholecystitis was confirmed with ultrasonography or computed tomography, and all cases were acalculous cholecystitis. At first, percutaneous transhepatic gallbladder drainage was performed; then, laparoscopic cholecystectomy (LC) was tried an average of 12(range: 11-13) days later. An laparoscopic cholecystectomy was successfully done in only one case, the other cases being converted to an open cholecystectomy due to severe inflammation. Conclusion: The incidence of acaculous cholecystitis was 4.3% after multiple trauma with fractures. We should consider cholecystitis in patients with abdominal pain, fever and elevated LFTs after multiple trauma. (J Trauma Inj 2012;25:203-208)