| Abstract: |
Chronic ac,l!culuus cholecystitis (CAC) is a controversial disorder and surgeons an~ reluctant to perfonn cholecystectomy in the absence of calculi.This study was done on (30) patients with chronic acalculous cholecystitis to evaluate the role of cholecystectomy in management of these cases.In our study we noticed that, chronic acalculous cholecystitis is a disease of middle aged females with maximum age peak from 30- 45 years and mean age of 40.7 years.The female to male ratio was 6.5 to 1.All the patient~ had right upper quadrant pain with or without fatty dyspepsia, lJausea. or vomiting, highly suggestive of gall bladder origin.On examination, there were be tenderness in the right hypochondrium and positive Murphy’s sign and epigastria tenderness may be present.Associated medical diseases were present in eight patients, three were diabetic, three Wi’~re hypertensive one was ischaemic heart disease, one was rheumatic hemi disease. Also one female patient with psychogenic disorders.Routine laboratory investigations were done for all patients which include urine and stool analysis , complete blood picture renal and liver functions tests, senml cho] esterol and serum lipase and all revealed no abnonnalities except four patients were anaemic, three patients were diabetic, two patients showed elevated senun cholesterol level, two patients with low senun albumin and thre<;; patients with elevated liver enzymes.Ultrasonography showed gallbladder abnonnalities in 27 of 30 patients (90%). The commonest [mdings were increased gallbladder wall thickness in26 patients (86.~1%), positive sonographic Murphy’s sign in 18 patients (60%), biliary mud in 10 patients (33.3%) , and gallbladder polyp in one patients (3.:\%).The sensitivity of U.S. was 92% and specificity was 33.3% while, accuracy was 86.6%.Oral cholecystography (O.C.G) showed abnormalities 26 patients (86.70/0) while 4 patients showed nonnal O.C.G. The cOlrunonest O.C.G findings were, poor emptying in response to fatty meal in 18 patients (600/0), prolonged I)pacification after 36 hours in Ilpatients (36.7%) non or poor visualization of the gallbladder in 9 patients (30%) defonned gall bladder in 3 patients (10%) mId soft tissue shadow in one patients (3.3%).sensitivity of O.C.G was (89.3%) and the specificity was 50% while the accuracy was (86.6%).Upper gastrointestinal endoscopy is important to be done for all patients with C.A.C to exclude oesphago- gastro- duodenal patholob’Y.Colonoscopy was done for three patients (l 0%) with history of colonic disturbances.Cholecystectomy was done for all patients without mortality and minimal morbidity.Culture of bile showed bacterial growth in 11 patients ( 36.7 % )and the commonest organism was E-coli.Histopathological examination of all removed gall bladders showed chronic inflammation in 28 patients (93.3%) while two cases were nonnal.The outcome of cholecystectomy after six months follow up showed that 25 patients (83.3%) become completely symptoms free ”excellent results”, three patients (I 0%) were improved~but still having some complaints ”satisfactory results” while the other 2 patients (6.7%) not benefit from cholecystectomy.
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