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International Journal of Recent Trends in Science and Technology, ISSN 2277-2812 E-ISSN: 2249-8109
Volume 16, Issue 1, Aug 2015 pp 66-69
Research Article
A comparative study of symptomatic and radiologic findings in cases of gall bladder disease undergoing cholecystectomy
Sushant Kumar1, Pranaya Kunal2, Deepak Kumar Yadav3
1Associate Professor, 2Assistant Professor, 3PG Student, Department of Surgery, MGM Medical College and LSK Hospital, Kishanganj, Bihar, INDIA.
Abstract
A prospective clinical study of 100 selected cases admitted in the Department. Of General Surgery, M.G.M Medical College and L.S.K. Hospital, Kishanganj during the period of July, 2012 – September, 2014 was undertaken to assess the mode of clinical presentation, laboratory and radiological impressions and finally their management. A brief review of available literature was also made. Majority cases (35%) belonged to age group of 31-40yrs with a female preponderance (F:M- 3:1) with most of the women in their child bearing age. Pain abdomen over the right hypochondrium with referred pain to the inferior angle of scapula and positive Murphy’s sign were the commonest clinical presentation followed with nausea, vomiting, flatulence and dyspepsia. Only 1 case had jaundice during the first clinical presentation. Ultrasonography of abdomen not only revealed evidence of gall stones with impressions of acute or chronic cholecystitis in 95% cases but also revealed some changes in common bile duct, liver, pancreas etc. Total WBC count was found to be elevated (mild to moderate) in 100% cases. Liver function test results- 16% cases was with elevated serum bilirubin, 24% cases with elevated alkaline phosphatase and 6% with elevated liver enzymes was observed. All cases were managed conservatively in acute phase of which 20% cases needed early operation being refractory to conservative means. Rest underwent interval cholecystectomy after 4-6 weeks. Open Cholecystectomy through right subcostal Kocher’s incision were carried out in all cases out of which Choledocholithotomy and Choledochoduodenostomy were done in 5% cases. 80% cases revealed multiple stones, 14% solitary stone and 3% sludge only. Macroscopically 60% cases showed mixed stones, 22% pigment stones and 6% cholesterol stones. Macroscopically 72% revealed gross thickening with fibrosis, 28% with congestion. Microscopically chroniccholecystitis was found in 100% cases. Bacteriological examination of gall bladder contents showed 56% to be sterile, Klebsiella sp. And Staphylococcus aureus predominant in infected cases (42%). E. coli, Enterococcus, Enterobacter were also detected. The post operative period of all cases were uneventful except pain abdomen and wound sepsis in few. There was no mortality and significant morbidity.
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