Gallstones preventing ultrasonographic visualization of the gallbladder

Laing, F C; Gooding, Gretchen A. W.; Herzog, Karen A.

doi:10.1007/bf02256387

Cited by 14 publications

(4 citation statements)

References 8 publications

(8 reference statements)

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“…Wall echo shadow sign if present at neck or Hartmann's pouch of gall bladder can present in viewing the anatomical landmarks for safe cholecystectomy. 6 All these factors increase the incidence extra hepatic biliary injuries during laparoscopic cholecystectomy. The conversion to open cholecystectomy rate can increase because of difficulties during laparoscopic cholecystectomy.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic cholecystectomy in wall echo complex gall stone disease: a study

Arora

2017

Int Surg J

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Background: There are so many subtitles for difficult laproscopic cholecystectomy. Stone in the neck of gall bladder constitutes one of the entities. Wall echo complex is an ultrasound terminology used for cholelithiasis. It has three layers, first the pericholecystic fat between gallbladder and liver. Second layer consists of gall bladder wall. The third layer consists of echogenic stone itself. Wall echo complex is one of the entities which constitute difficult laproscopic cholecystectomy. Wall echo complex in the neck of the gall bladder is particularly difficult gall bladder where the conversion rates are high.Methods: The study was conducted in Department of Surgery. Standard four port cholecystectomy was done in 50 patients. Wall echo complex in all these patients was reported by ultrasonologist. Difficulties in operating wall echo complex cholelithiasis consisted of dissection of neck of gall bladder due to adhesions and a sleeve of fat covering the calot’s triangle. The difficulty of wall echo cholelithiasis was managed by opening the neck of gall bladder and evacuating the stones into a separate latex bag. By this procedure the difficult wall echo cholelithiasis was managed in all cases. Ligaclips were used for ligation of cystic duct, cystic artery and pericholecystic veins.Results: The evacuation of stones from the neck of gall bladder led to an easy cholecystectomy in 46 patients while the four patients had conversion to open cholecystectomy.Conclusions: Wall echo complex although an ultrasonologists entity but is a difficult gall bladder for laproscopic cholecystectomy.

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Section: Introductionmentioning

confidence: 99%

Laparoscopic cholecystectomy in wall echo complex gall stone disease: a study

Arora

2017

Int Surg J

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“…The WES triad has been recognized as an important ultrasound finding, because it allows one to confidently diagnose cholelithiasis [4][5][6]. However, the non-visualization of the gallbladder accompanied by posterior acoustic shadowing makes the diagnosis of cholecystitis difficult.…”

Section: Discussionmentioning

confidence: 98%

The significance of the wall echo shadow triad on ultrasonography: a case series

2010

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Background The wall echo shadow (WES) triad, also known as the double-arc-shadow sign consists of a welldefined near wall, echos from stones immediately beneath the wall, and posterior shadowing caused by strong echoes from stones in the gallbladder fossa. It has been used for over 20 years as a nonspecific finding suggestive of a gallbladder lumen filled with either multiple stones or one large stone (Miller et al. J Emerg Med 30(1):69-74, 2006; Blaivas et al. Acad Emerg Med 10(6):1020-1023, 1999; Raptopoulos et al. AJR Am J Roentgenol 138(2): [275][276][277][278] 1982). In the past, the WES triad has been correlated with underlying chronic cholecystitis. However, there are no studies that compare clinical findings to a gold standard such as surgical pathology. Case reports Three cases of the WES triad were reviewed at New York Medical Hospital of Queens over a 16-month period. Case reports Case 1A 79-year-old female presented to the Emergency Department (ED) with right upper quadrant (RUQ) abdominal pain radiating to the right flank for 2 weeks. Symptoms were associated with subjective fevers and anorexia. The patient denied nausea or vomiting. Her past medical history was significant for hypertension, hyperlipidemia and hypothyroidism. Vital signs were normal. Laboratory tests including white blood cell count, total bilirubin and liver function tests were all normal. A RUQ ultrasound was remarkable for echogenic shadowing seen from the level of the gallbladder fossa representing a gallbladder filled with stones ( Fig. 1). No sonographic Murphy's sign was elicited. There was no gallbladder wall thickening. The patient had resolution of her abdominal pain and was discharged with outpatient surgical followup. 19 days later, an elective laparoscopic cholecystectomy was performed. The pathology report was consistent with a diagnosis of acute and chronic cholecystitis. Case 2A 29-year-old male presented to the Emergency Department with RUQ pain associated with nausea and vomiting. The patient had no significant past medical history. The vital signs were normal. The physical exam was significant only for RUQ tenderness. The patient was discharged from the Emergency Department diagnosed with cholelithiasis after evaluation with normal laboratory results, normal computed tomography (CT) scan of the abdomen and an ultrasound that demonstrated the WES triad. The patient returned to the Emergency Department 1 month later with

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“…In the fasting subject, the most common reason for gallbladder nonvisualization is a contracted gallbladder full of stones [4,5]. The ultrasonic features of a contracted gallbladder with stones include a collection of echoes with acoustic shadowing in the region of the gallbladder bed that do not move with change in the patient's position [6] or on repeat examination.…”

Section: Discussionmentioning

confidence: 99%

“…Calculi are usually easy to identify by the strong echo within the bile-filled gallbladder and the acoustic shadow deep to the echo. However, if the gallbladder is contracted and contains little or no bile, it can be very difficult to identify [4,5]. Furthermore, a contracted gallbladder full of stones can be mimicked by a gasfilled loop of bowel.…”

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confidence: 99%