Background: The primary objective of our study was to review the portfolio of patients with xanthogranulomatous cholecystitis and their outcomes.
Methods: Retrospective analysis of information on 64 patients was done to examine age, clinical symptoms and findings, preoperative screening, operational results, surgical history, length of hospital stay, and postoperative problems.
Result: There were 44 women and 56 males, with a mean age of 55 ±11.4 years. Out of 100 patients, 57 had gallbladder stones, 12 had adenomyomatosis plus stones, and 3 had polyps, according to preoperative ultrasonography. 4 individuals had acute cholecystitis, while 14 had chronic cholecystitis. 5 of the 11 individuals who underwent abdominal computed tomography had thickening of the gallbladder wall. In 4 cases, frozen section exams were performed, 1 patient underwent a radical cholecystectomy because of probable malignancy.
Conclusion: Diagnosis of xanthogranulomatous cholecystitis on the basis of preoperative or intraoperative diagnosis of is challenging, and pathologic evaluation is the only method that may provide a conclusive answer.
Polytrauma in a 55 years male due to blunt trauma like fall from a height involving fracture of long bones, undisplaced fracture pelvis, fracture multiple ribs with a preliminary diagnosis of eventration of the hemidiaphragm in a apparently hemodynamically stable patient with a normal CT scan of brain, though poses a major physiological challenge, however runs a better prognosis. But with the passing of hours as patient develops respiratory distress and chest and abdomen CECT confirms a large lacerated hemidiaphragm with herniation of abdominal visceras occupying the hemithorax with lung collapse, alarms the gravity of the injury. An uncommon stress ulcer duodenal perforation on the 2nd day of admission with ensuing pyoperitoneum further threatens the hemodynamics and enhances the morbidity and mortality. This warrants an active and prompt action by multispecialty involvement. Emergency laparotomy to address the pyoperitoneum, closure of the duodenal perforation, reduction of the herniated abdominal visceras from the hemithorax, thorough saline lavage of the abdominal and involved chest cavity, placement of intrathoracic chest tube drain, repair of the lacerated diaphragm, placement of peritoneal cavity drains and closure of the abdomen settles the issue of damage control surgery in this case. Postoperative care in the ICU with ventilator support, higher antibiotics and supportive medications, repeated laboratory and radiological tests helps in overcoming the hemodynamic crisis in such critically ill patients. Our patient subsequently developed pneumonitis and had a postoperative protracted course in the ICU and finally shifted to the general ward on 7th day of his admission.
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