Cholelithiasis and Cholecystitis: RESULTS

A total of 46 patients had cholecystectomy for inflammatory gallbladder disease over a five-year period (1997-2001). This gives an average of nine per year. In the first three years of this study, 18 (39.1%) patients were seen, but in the next two years 28 (60.9%) patients had cholecystectomy for inflammatory gallbladder disease. The yearly incidence is shown in Figure 1. As shown in Figure 2, the majority (52.2%) of the patients were ages 40-59 years, while 39.1% were <40 years of age. The overall male:female ratio was 1:4.8, but in patients <30 years and those >40 years, they were 3:2 and 1:13, respectively. Table 1 shows the parity of the female patients. Thirty-two of the 38 female patients had had >2 children at the time of presentation.

Table 1. Parity of the female patients with cholelithiasis and cholecystitis in llorin, Nigeria (n=38)

Parity Number Percentage
0

4

10.5

1

2

5.3

2

4

10.5

со

18

47.4

4+

10

26.3

Total

38

100.0

Acute cholecystitis was the mode of presentation in nine (19.7%) patients, while 37 (80.4%) presented with chronic cholecystitis. Right hypochondrial and epigastric pains were the most common symptoms, occurring in all the patients. Forty (87.0%) patients had nausea and vomiting. One patient gave a history of transient jaundice at presentation, while another patient was still jaundiced at presentation. In 36 (78.3%) patients, there was history suggestive of more than one previous episode of biliary colic. About 50% of the patients had had symptoms suggestive of biliary tract disease for more than one year. Many of the patients have been on treatment for dyspepsia or suspected peptic ulcer disease for a period ranging from four weeks to five years (median was six months). There was no associated hypertension, diabetes mellitus or other comorbid obvious medical condition in these patients. On examination, six out of nine (66.7%) of the patients who presented with acute cholecystitis had a positive Murphy’s sign. Only four (8.7%) patients had a body mass index (BMI) >30kg/m2 and thus were obese. The remaining patients 42 (91.3%) had normal BMIs.

Ultrasonography was able to diagnose calculous cholecystitis in 40 out of 41 patients with stones giving a sensitivity of 97.6%. In all of these patients, the common bile duct was normal. There was one case of Mirizzi syndrome type 1 that was only diagnosed at operation. Ultrasound missed the correct diagnosis even though it picked the gallstones. There were six patients with abnormal hemoglobin (two had HbAS, four had HbSS), and the remaining 40 patients had HbAA.

Figure 1. Yearly distribution of cholelithiasis

Figure 1. Yearly distribution of cholelithiasis and cholecystitis in llorin, Nigeria, 1997-2001 (n=46)

All patients with acute cholecystitis had nonoper-ative treatment initially and interval (elective) cholecystectomy six weeks later. One of the patients was found to have Mirizzi syndrome type 1. Only five patients had acalculous cholecystitis. All the remaining patients had calculous cholecystitis.
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The number of stones found in the gallbladder ranged from 1 to 250. The stones were mostly multiple in 43 (93.5%) patients and only solitary in three (6.5%) patients. Average number of stones were eight. Five (10.9%) patients had pigmented stones (four of these were known cases of HbSS, the fifth had HbAA), while the remaining had mixed and cholesterol stones.

Figure 2. Age and distribution

Figure 2. Age and distribution of cholelithiasis in University of llorin Teaching Hospital, 1997-2001
One of the patients had transient jaundice that lasted about 72 hours during the immediate postoperative period, but it subsequently cleared. There was no death as a result of the cholecystectomy or within 30 days of the procedure.
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The histopathology results of all removed gallbladders confirmed cholecystitis.

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