Study of Clinical Profile of Cholelithiasis in Kims, Hubli

Abstract

BACKGROUND Gallstone disease is one of the most common problems affecting the digestive tract. The clinical spectrum of cholelithiasis ranges from an asymptomatic state to fatal complications. The prevalence of gallstones appears to be rising and each year approximately one million new cases are discovered. In India it is estimated to be around 4%, whereas in the western world it is about 10%. It is possibly due to change in dietary habits and lifestyle modifications. Studies on gallstone composition carried out in different parts of the world indicate a close link with dietary habits and ethnicity. MATERIALS AND METHODS This is a descriptive study conducted in Department of Surgery, KIMS, Hubli from April 2014 to Nov 2015. Totally 56 patients diagnosed to have symptomatic cholelithiasis with or without choledocholithiasis on Ultrasonography, who underwent surgery were studied. Initially all cases were examined, investigated, detailed history was taken and operated during the period. All patients have undergone detailed investigations; relevant investigations like Bile Culture and Cytology and Biochemical Analysis of Gallstones. RESULTS The highest incidence of cholelithiasis was in the 5th and 6th decade with maximum incidence in the 6th decade. There was an increased incidence in females, i.e. M: F= 1: 27. Pain was the most common symptom present in 94.64% of the patients, nausea and vomiting were the second most common symptoms presenting in 26.78% of patients and jaundice in 7.14% of the patients. Tenderness in the right hypochondrium was the most common sign present in 66.07% and guarding in 5.35% of the patients. 75% patients had mixed diet and 25% patients were vegetarian. Ultrasonography was the investigation of choice in our hospital. 78.57% patients had gallstones, 7.14% of patients had CBD stone, 17.85% of patients had single stone, 60.71% of patients had multiple stones, 19.64% of patients had thickening of gallbladder, 14.28% had dilated CBD, 21.42% had contracted GB and 25.00% patients had associated findings. 53.58% of patients underwent laparoscopic cholecystectomy, 14.28% of patients underwent open cholecystectomy and associated procedure with cholecystectomy done in 17.86% of patients. Wound infection was the most common post-operative complication occurring in 12.50% patients and 5.35% patients had post-operative bile leak. Histopathology revealed 69.63% patients had chronic cholecystitis, 10.70% patients had calculous cholecystitis and 3.57% had acute cholecystitis with cholelithiasis. Bile culture revealed no growth in 39.28% patients. Gallstones analysis showed pigmented stone in 47.36% of the cases as the most common variety, mixed stones in 42.10% of cases followed by cholesterol stones in 10.52% of the cases. There was no mortality in the present study. CONCLUSION Gallstones disease is more common in female sex. The incidence of gallstones was higher in the 5th and 6th decades of life. Gall stones incidence is more in non-vegetarians than vegetarians. Upper abdominal ultrasonography was t...