exudates and Cholecystitis

We describe here the first laparotomy involving a COVID-19 patient in Malaysia. A 60-year-old man screened positive for SARS-CoV-2 in March 2020 and developed acute abdomen in the ward in Hospital Sultanah Bahiyah, Kedah. He underwent laparotomy and cholecystectomy for gangrenous cholecystitis. All personnel adhered to infectious control precautions, donning full personal protective equipment (PPE) throughout the surgery. Post-operatively, due to raised septic parameters, he was carefully diagnosed with and treated empirically for superimposed bacterial sepsis instead of cytokine release syndrome, with confirmed blood culture of Klebsiella pneumoniae. Patient was discharged well later. None of the staff involved in his care developed COVID-19 infection.

Topics: Abdomen, Acute; Cholecystectomy; Cholecystitis; COVID-19; Gangrene; Humans; Laparotomy; Malaysia; Male; Middle Aged; Personal Protective Equipment

Most gallbladder carcinoma cases are suspected pre-operatively or intra-operatively. In Malaysia histopathological examination of cholecystectomy specimens has become routine practice. The aim of this study was to assess the impact of routine histological examinations on cholecystectomy specimens from an Asian demographic, which may differ from a Caucasian demographic.. A retrospective study was performed of all histopathology reports for cholecystectomies (laparoscopic and open) undertaken over a period of 12 years (1997-2008) in a single teaching hospital.. A total of 1,375 gallbladder specimens were sent for histopathological analysis, with 7 (0.5%) being reported as malignant while only three (0.2%) were found to contain primary gallbladder carcinoma. Other premalignant findings included two specimens with dysplastic changes of the mucosa and one tubulovillous adenoma with a dysplastic epithelium. From the ten malignant and premalignant specimens, seven were diagnosed pre-operatively, two were suspected intra-operatively and one was diagnosed with dysplastic changes on the histopathology report post-operatively.. This study supports earlier research carried out in the UK and the demographic difference does not affect the impact of the histology examination on cholecystectomy specimens in diagnosing this disease. A selective policy is recommended in Malaysia.

Topics: Adenocarcinoma; Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Asian People; Child; Cholecystectomy; Cholecystitis; Cholecystitis, Acute; Chronic Disease; Female; Gallbladder Neoplasms; Humans; Malaysia; Male; Middle Aged; Postoperative Care; Preoperative Care; Referral and Consultation; Retrospective Studies; Tomography, X-Ray Computed; Young Adult

An audit of 1122 cholecystectomies for a 6-year period from 2000 to 2005 was done to review cases of primary carcinoma of gallbladder. There were nine cases of primary carcinoma of gallbladder. Six were females and 3 males. Their ages ranged from 27 to 81 years. Pre-operatively, only 2 (11.1%) were clinically suspected of carcinoma while 3 were diagnosed as cholecystitis, two as cholelithiasis and one case each of ovarian cyst and intestinal obstruction. Intra-operatively, an additional four cases were suspected as gallbladder carcinoma with the remaining three cases diagnosed as only having gallstones. Altogether only 5 (55.6%) cases were associated with gallstones. Six (66.67%) cases of gallbladder carcinoma had abnormal macroscopical lesions noted; either papillary lesions or polypoid masses. The remaining 3 cases had thickening of the wall, consistent with chronic cholecystitis. Seven cases were found histologically to be adenocarcinoma. Of these, two were papillary carcinoma and one signet ring cell type adenocarcinoma. One case of squamous cell carcinoma and one case of adenosquamous carcinoma were noted. This study highlights the importance of careful macroscopical and microscopical evaluation of a routine pathological examination of gallbladder removed for cholecystitis or cholelithiasis. It provides the incidence of gallbladder carcinoma in patients who underwent cholecystectomies in a government hospital in Johor, Malaysia.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma; Cholecystectomy; Cholecystitis; Diagnosis, Differential; Female; Gallbladder Neoplasms; Gallstones; Humans; Malaysia; Male; Middle Aged; Retrospective Studies

Topics: Age Factors; Biliary Tract Diseases; China; Cholangitis; Cholecystitis; Cholelithiasis; Ethnicity; India; Malaysia; Obesity; Sex Factors