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Son, Kim, and Kim: Beneficial Effect of Cholecystography following PGBD for Complicated Acute Cholecystitis: Detection of Unsuspected CBD Stone
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2009; 76(1): 43-46.

Published online: 31 January 2009

DOI: https://doi.org/10.4174/jkss.2009.76.1.43

Beneficial Effect of Cholecystography following PGBD for Complicated Acute Cholecystitis: Detection of Unsuspected CBD Stone

Dong-Hyuk Son, M.D., Kang-Sung Kim, M.D., Kaon-Hong Kim, M.D.

Department of Surgery, Dongkang Hospital, Ulsan, Korea.

grsks@hanmail.net

Received 24 June 2008       Accepted 26 August 2008

Copyright © 2009 The Korean Surgical Society

Abstract

Purpose

Frequency of combined CBD stones on cholelithiasis has been known to range 5~20% in several reports, and diagnostic tools are USG, MDCT, MRCP and ERCP. Predictive factors of CBD stone for cholelithiasis were diameter of CBD, elevated liver enzyme, multiple small sized GB stones and concurrent pancreatitis. However, unsuspected CBD stone for acute cholecystitis is troublesome for patients and surgeons.

Methods

We retrospectively reviewed Percutaneous gallbladder drainage (PGBD) for acute complicated cholecystitis from October 1996 to October 2006. Indications for PGBD are clinical symptoms (sepsis) & signs of peritonitis and radiologic findings such as GB empyema, gangrenous cholecystitis and pericholecystic fluid collection. Total laparoscopic cholecystectomy was 1,357 cases, and PGBD for acute complicated cholecystitis was 13.8%.

Results

Combined CBD stone rate was 13.6%. Whereas, unsuspected CBD stone was 0.5% (9 cases), 7 in calculous and 2 in acalculous cholecystitis. No. of stone was 1 in 7 cases, 2 in 1 case and 3 in 1 case. Size of stone was less than 5 mm in all cases. Diameter of CBD was not increased in all cases (less than 1 cm) and liver enzymes showed no elevation in all cases. Management for unsuspected CBD stone was preoperative endoscopic lithotripsy in 8 cases and postoperative fluoroscopic lithotripsy in 1 case.

Conclusion

Cholecystography following PGBD for acute complicated cholecystitis is a useful diagnostic modality for detection of unsuspected CBD stone.

Keywords: Unsuspected CBD stone, Cholecystography, Acute complicated cholecystitis

Figures and Tables

Table 1
Comparison of PGBD group and Non-PGBD group in patients with complicated cholecystitis
jkss-76-43-i001

*PGBD = percutaneous gall bladder drainage; †CBD = common bile duct.

Table 2
Clinical analysis of patients with unsuspected CBD stone
jkss-76-43-i002

*CBD = common bile duct.

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