Specific Bile Microorganisms Caused by Intra-Abdominal Abscess on Pancreaticoduodenectomy Patients: A Retrospective Cohort Study

We retrospectively collected PD patients with a performance of bile culture between 2007 and 2019 in our institute. As to bile culture, we used a swab to do intraoperative bile cultures after transection of the CBD. IAA was defined as the documental bacteriological culture from either a turbid discharge from the intraoperatively placed drain in patients with a clinical picture consistent with infection or a postoperative fluid collection managed by CT-guided placement of drains. A total of 1244 PD patients were identified, and 539 (43.3%) subjects with bile sampling were included for analysis. Among these study patients, 433 (80.3%) developed bile contamination (positive bile culture). Bile contamination showed a significantly higher rate of IAA compared to non-bile contamination (17.1% vs. 0.9%, p < 0.001). The rate of co-shared microorganisms in both bile and abscess was 64.1%. On the multivariate analysis, age and specific bile microorganisms (Enterococcus species, Escherichia Coli, Streptococcus species, Citrobacter species, and Candida) are significantly associated with development of IAA. Specific bile microorganisms are the highly significant factors associated with development of IAA. The strategy to prevent bile spillage during PD should be considered to minimize afterward contamination of the abdominal cavity and prevent IAA.

Profile and Outcome of Patients with Acute Cholangitis in a Tertiary Center in South India

Background The mainstay of management of acute cholangitis includes endoscopic or percutaneous biliary drainage and antimicrobial therapy. We aimed to study the profile and outcomes among patients with acute cholangitis who underwent endoscopic biliary drainage at our center. Methods Seventy consecutive patients with acute cholangitis diagnosed and managed as per the Tokyo Guidelines 2018 for acute cholangitis between June 1, 2018 to December 31, 2019 were prospectively studied. Clinical, etiological and microbial profile, therapy, and patient outcomes were analyzed. Results Choledocholithiasis (54.3%) and benign biliary stricture (28.6%) and malignancy (17.1%) were common etiological factors. Thirteen patients (18.6%) had underlying chronic liver disease. Moderate-to-severe cholangitis was seen in 67.7% of patients with high and very high grade as compared with 54.5% with medium grade of Charlson comorbidity index (CCI) and 41.2% of patients with low grade of CCI. Elevated C-reactive protein, low albumin, and prolonged international normalized ratio were associated with severe cholangitis. Bile culture was positive in 62.9% and blood culture was positive in 15.7% of patients. Bile cultures were predominantly polymicrobial in contrast to blood cultures (53.8 vs. 18%). Escherichia coli was the predominant isolate in blood and bile. Multidrug resistant (MDR) organisms were seen in 79.5% of positive bile cultures. Conclusions A positive blood or bile culture, but not presence of multiple organisms or presence of MDR organisms in bile, was associated with severity of cholangitis. There was no mortality among these patients in-hospital or at 28-days.

Porcelain gallbladder and its relationship to cancer

Summary Background Porcelain gallbladder (PGB) is defined as calcium deposits encrusting the internal visceral layer, which becomes hard, brittle, and bluish. Porcelain gallbladder is rare and has been found in less than 1% of routine cholecystectomy specimens. Several studies report an incidence of gallbladder carcinoma (GBC) associated with gallbladder calcification varying between 12.5 and 61%, data which have been known for 60 years. There is a lack of information concerning PGB and its association with GBC, and the aim of this study is to better define this relationship. Methods A total of 10 patients were found to have PGB in 1050 consecutive routine surgical cholecystectomies. Clinical and laboratory findings, gallbladder histologic examination, bile culture, and bile pH were related to stone composition analysis performed by X‑ray diffraction using Perkin–Elmer (Perkin Elmer Corp. Norwalk, CT, US) 1625 FTIR. Results Among the 10 patients with PGB, complete calcification of the entire gallbladder wall was present in six cases, while four patients had partial calcification. Gallstones were present in all cases of PGB, multiple stones in nine cases and a single stone in one case. Bile culture was performed in all patients of the series. Among the 10 cases with PGB, culture was positive in two cases. Conclusion PGB is a disease as rare as it is subtle. Moreover, the chronic stimulation by stones can generate an initial dysplasia that will subsequently turn into a neoplasm: the cancerization risk is probably no different from long-standing cholesterol or combined stones, but as risk factor for cancer it requires early cholecystectomy.

Study of Bacterial Aetiogenicity of Pigment Gall Stones by Culture of Nidus of Calculus and correlation between Stone Culture and Bile Culture

Background: Calculus disease of biliary tract is a major public health problem in north Kashmir and pigment gall stones form a significant portion of gall stones in our region. In this study we prospectively studied 84 cases of pigment gall stones to examine the role of bacteria in the formation of these stones. Objective: To study the bacterial aetiology of pigment gall stones. Methods: A hospital based prospective study of 84 consecutive cases of pigment gall stones was done from December 2012 to November 2019 and the results of stone culture and bile culture were statistically analysed. Informed consent was obtained from all the patients in the study group. Results: A total of 84 cases studied included 32 (38.09%) male patients and 52(61.91%) females patients. The median age was 48.5 years and mean age was 46.2 years. Of 84 patients, 21(25.00%) had black pigment stones and 63 (75.00%) had brown pigment stones. 61 (72.62%) patients presented with biliary colic and 24(28.57%) patients had chronic cholecystitis . Bile culture was positive in 46 (54.76%) patients and stone culture was positive in 70(83.33%) patients. Conlusion: A strong association was observed between stone culture and bile culture results (showing similar beta-glucronidase producing bacteria) and pigment stone formation.