Primary Gallbladder Cancer Discovered Postoperatively after Elective and Emergency Cholecystectomy

Abstract

Background: Gallbladder cancer is a rare neoplasm associated with high mortality and poor prognosis. It is usually correlated with cholelithiasis and presents more commonly in elderly and female patients. Diagnosis is seldom made preoperatively because of the indolent progression of the tumor. Methods: The hospitalization and surgical records of our surgical department were examined from January 1992 to December 2001, searching for patients who had undergone cholecystectomy. Additionally, the histopathological diagnoses of the same period were studied searching for patients with the diagnosis of gallbladder cancer established postoperatively and not intraoperatively by frozen section. Results: In the period of 1992-2001, a total of 1,536 cholecystectomies took place and 14 cases of gallbladder cancer were diagnosed postoperatively. The ratio of men to women is 3/ 11 with a mean age of 69.4 years. The clinical symptoms were non-specific and mortality was 57%. Conclusion: In most cases gallbladder cancer is diagnosed after cholecystectomy and even in these cases it can be in an advanced stage and the prognosis of this rare neoplasm is poor.

Pilonidal Disease- Review Article

“…[5,19] • Pilonidal disease may arise in one of three forms: [9] Quiescent phase Acute abscess [9] Sinus tracts [9] Complex disease characterized by chronic or recurrent abscesses with extensive, branching sinus tracts [9] During quiescent phase -• Pilonidal sinus is characterized by the existence of a midline pit in the natal cleft typically identified 4 to 8 cm from the anus. [23] • The skin enters the sinus giving the opening a smooth edge. [23] • This primary tract leads into a subcutaneous cavity, which contains granulation tissue and usually a nest of hairs that are present in two thirds of cases in men and in one third of those in women and may be seen projecting from the skin opening.…”

“…[23] • The skin enters the sinus giving the opening a smooth edge. [23] • This primary tract leads into a subcutaneous cavity, which contains granulation tissue and usually a nest of hairs that are present in two thirds of cases in men and in one third of those in women and may be seen projecting from the skin opening. [23] • Many patients have secondary lateral openings 2 to 5 cm above the midline pit.…”

“…[23] • This primary tract leads into a subcutaneous cavity, which contains granulation tissue and usually a nest of hairs that are present in two thirds of cases in men and in one third of those in women and may be seen projecting from the skin opening. [23] • Many patients have secondary lateral openings 2 to 5 cm above the midline pit. [23] • The skin opening and the superficial portion of the tract are lined with squamous cell epithelium, but the deep cavity and its extensions are not.…”

“…[23] • Many patients have secondary lateral openings 2 to 5 cm above the midline pit. [23] • The skin opening and the superficial portion of the tract are lined with squamous cell epithelium, but the deep cavity and its extensions are not. [23] Acute abscess formation in pilonidal sinus tract(s)…”

“…[9] • Intervention may range from simple incision and Drainage to wide excision with extensive reconstructive procedures. [9] • The treatment of pilonidal disease is mostly surgical [23] • Clear criteria for selecting the treatment method do not exist [25] . There is no consensus regarding the optimal surgical technique [21] • Ideally, the selected treatment should involve a simple procedure with minimal morbidity, a short healing time, and low recurrence rates.…”