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Gallbladder cancer is a relatively rare cancer of the gastrointestinal tract, most commonly detected (approximately 95% of cases) in the most advanced clinical stage IV and burdened with high mortality rate. This is mainly due to the nonspecific symptoms in the early stages of the disease. The remaining cases of gallbladder cancer are usually detected after surgery due to gallstone disease. Gallstones, their size and pancreatic juice reflux into the gallbladder are risk factors in the development of gallbladder cancer. In this paper the authors carried out a retrospective research based on an evaluation of a group of 38 patients treated surgically due to the gallbladder cancer in the years 2005-2012 in the Second Department of General and Gastroenterological Surgery in Białystok Medical University Hospital. In this group there were 29 women and 9 men, in age between 48-86 years. Although women suffered from gallbladder cancer more often than men, their survival rate was significantly better after the surgery. The research showed some benefits of extended surgical procedures even in patients with advanced stages of the disease, while the effectiveness of surgical treatment depends mainly on the possibility of radical resection of the primary lesion and, eventually, the resection of lymph nodes and other infiltrated tissues.
PL
Wrodzone anomalie i odmiany anatomiczne pęcherzyka żółciowego są elementem ryzyka powikłań podczas cholecystektomii laparoskopowej. Do SOR została przyjęta 28-letnia pacjentka bez wcześniejszego wywiadu, skarżąca się na bóle w nadbrzuszu promieniujące do pleców połączone z zaparciami, nasilające się w ciągu 5 dni. Nie stwierdzono kamicy w dystalnej części przewodu żółciowego wspólnego (PŻW). Nie stwierdzono również zmian guzowatych w trzustce ani poszerzenia przewodu trzustkowego. Stwierdzono natomiast duży, 20 mm kamień w pęcherzyku oraz drobną kamicę w szyi pęcherzyka. Postawiono rozpoznanie objawowej kamicy pęcherzyka żółciowego z migracją kamienia i podjęto decyzję o hospitalizacji i leczeniu objawowym w celu poszerzenia diagnostyki poszerzenia PŻW. W badaniu MRI dróg żółciowych stwierdzono wrodzoną duplikację pęcherzyka żółciowego. Chora została zakwalifikowana do planowej laparoskopowej cholecystektomii miesiąc póżniej w ramach pobytu jednodniowego. Zabieg przebiegł bez powikłań ze względnie prostym preparowaniem struktur trójkąta Calota.
EN
Congenital gallbladder anomalies and variations in their anatomical position are associated with an increased risk of complications after laparoscopic cholecystectomy. A 28-year-old female patient with no previous medical history, presented to the emergency department with complaints of epigastric pain, radiating to the back, associated with constipation, and progressively increasing in intensity over 5 days. No gallstones were visualized in the distal CBD. Neither any pancreatic mass, nor dilation of the main pancreatic duct was identified. A voluminous gallstone of 20 mm in the gallbladder and multiple microlithiasis in the gallbladder neck were identified. The diagnosis of symptomatic cholelithiasis with gallstone migration was retained, and the decision was taken to hospitalize the patient in order to institute symptomatic treatment and to carry out further investigations to explore the etiology of the CBD dilatation. On MRCP the presence of a congenitally folded gallbladder, containing gallstones was confirmed. The decision was made to operate on the patient one month later by laparoscopy. A laparoscopic cholecystectomy was performed one month later, on an outpatient basis. The surgery was carried out without any difficulty, and Calot’s triangle was dissected relatively easily.
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