Calculous Cholecystitis

INTRODUCTION: Gall Bladder is a pear shaped saccular organ, which stores bile, becomes a place for formation and growth of Gallstones. The Gallstone disease is more common in Western world Today the Incidence of cholelithiasis is increasing considerably in India, Possibly due to change in the dietary habits. Which is becoming westernized and the life style which is changing. In India, North India shows 7 times more incidence than that in South India. The operations on biliary tree and gall bladder rank next only to Hernia repair and appendicectomy in Northern India. In Southern India, picture is not clear. Prevalence of Cholelithasis, in Indian males and females is estimated as 4% and 6% respectively. The exact incidence of cholelithasis is not known. Prevalence of cholelithasis shows Improved detection due to Imaging modalities particularly ultrasonogram. Because of the Extensive studies of Etiology of gallstones and better understanding of the Pathogenesis in the past two decades, the management has become more appropriate and effective. Proliferating research on the minimal invasive surgery especially after 1988 with the advent of Laparoscopic surgeries, Percutaneous removal of stones and Extracorpereal shock wave lithotripsy has greatly motivated patients for undergoing early and effective management. AIMS OF THE STUDY: 1. To evaluate the age incidence, the sex incidence, the common etiological and risk factors of gall stones in this region. 2. To illustrate various types of clinical presentation in calculous cholecystitis. 3. To discuss the usefulness of different diagnostic procedures in a case of calculous cholecystitis. 4. To study the various modes of management and their results. 5. To study the bacteriology of the bile in calculous gall bladder disease. 6. To assess the incidence of postoperative complications. 7. To analyse the biochemical types of stones prevalent in this part of the country. 8. To study the histopathological changes in calculous gall bladder diseases. MATERIALS AND METHODS: Forty patients of clearly documented cases of Gallstone diseases of the Gall bladder and biliary tract admitted in the surgical units and the surgical Gastroenterology unit of Thanjavur Medical College Hospital between January 2005 to January 2006 constitute the material of this study. A detailed History including that about previous treatment was elicited in all patients and thorough clinical examination was done in them. Relevant preoperative investigations of blood, Urine, Plain X-ray abdomen and USG were done in all possible cases. The operative findings and postoperative complications were recorded and carefully analysed. The Gallstones removed were sent for Biochemical analysis in 24 cases and bile culture was done in 16 cases. The Gall bladder specimens of all the cholecystectomy cases were routinely sent for Histopathological examination. SUMMARY AND CONCLUSIONS: Gallstone disease is the commonest disease involving biliary tract and is associated with significant morbidity and mortality. Patients with gallstone are not a homogenous group. They are now being detected with greater frequencies, with the advent of Ultrasonogram. 40 cases of well documented calculous cholecystitis admitted in the Thanjavur Medical College Hospital during the period between jan 2005 and Jan’2006 were studied in depth. The following conclusions were made in our study: (1) The overall incidence of gallstone disease is 0.1% of all admissions during this period. (2) The age incidence varies between 16 and 62 years and the mean age of incidence is 45 years. Patients of 4th, 5th , 6th decades were the commonest victims. (3) A female preponderance of 3.4:1 was observed in our study. (4) Right Hypochondrial Pain was the commonest presentation of gallstone diseases. (5) Ultrasonogram of the abdomen was invaluable in the diagnosis of gallstones because of its simplicity, safety, repeatability and an accuracy of100% in our series. (6) Elective cholecystectomy was the most widely followed method of surgical treatment. Cholecystectomy starting at calot’s triangle was the commonest technique used. (7) Mortality rate in our series is 2.5%. (8) Mixed stones were the commonest variety in our study. (9) The commonest histopathological change associated with gallstone was chronic cholecystitis. Associated carcinomatous change in calculous cholecystitis is nil in our series. Medical dissolution of the stone though theoretical is not very popular with our Hospital patients, because of the non-availability LAPAROSCOPIC cholecystectomy is now replacing the open cholecystectomy. But in our institution. It is not available. However open cholecystecomy has its value in smaller hospitals and peripheral centers as the only method of treatment. It is therefore necessary that a surgeon should have the adequate knowledge and experience in this field. In Judicially selected, carefully prepared and operated cases, the results are bound to be gratifying