Benign tumours of the gallbladder and gallbladder stone disease populations.
The gallbladder is a small sac-like organ located on the visceral surface of the liver. Bile is produced in the liver and then, in response to appropriate neural, endocrine and paracrine influences, it plays a role in breaking down fats or oils in the gallbladder into smaller particles by contracting the gallbladder and relaxing the small muscular ring in the wall of the duodenum. The gallbladder is supplied with blood by a small artery.
In our population, stone formation is caused by an imbalance in bilirubin (bile pigment), calcium and cholesterol balance. Certain diseases can lead to elevated calcium levels, which, in addition to kidney stone formation, are involved in the development of gallbladder and gallstones. In such cases, it is always advisable to investigate the underlying disease in addition to removing the gallbladder. Other pathological conditions lead to the accumulation of gallstones.
The cause of benign tumours of the gallbladder is not known, but polyps with a large or growing tendency in the gallbladder wall should also be removed because of the risk of malignant transformation.
Complaints are raised when a large gallstone blocks the gallbladder duct, causing the gallbladder to increase in pressure and the gallbladder wall to become strained. If the stone is dislodged and the bile is allowed to drain, the crampy abdominal symptoms may disappear. In the absence of bile evacuation, the pressure increases and the bile may become over-infected with bacteria due to the bile spasm, eventually causing inflammation of the gallbladder. It is best to remove the gallbladder within 72 hours of the onset of inflammation.
If the inflammation is prolonged, perforation of the gallbladder, biliary peritonitis or liver abscess may develop.
Smaller stones can pass through the gallbladder duct into the bile ducts and block them, which is known as bile duct fouling. The first sign of stagnant bile in the liver may be yellow discolouration of the skin and cornea. The stools may become colourless and clay-like and the urine dark. Prolonged stasis can trigger inflammation of the bile ducts.
Bile duct stones may also block the pancreatic duct, wedged into a small opening in the duodenum, and pancreatitis may develop.
The exact cause of gallbladder tumours, which have a poor oncological prognosis, is currently unknown, but decades of chronic inflammation caused by gallstones may play a role in the development of gallbladder cancer. This is confirmed by the fact that gallbladder tumours do not usually develop in a stone-free gallbladder.
Gallbladder stones or polyps cause typical symptoms in the majority of cases.
jaundice
spasmodic pain under the right costal arch after eating, radiating towards the right shoulder blade and the vertebrae.
pain may also occur in the middle part of the abdomen
If the above symptoms are associated with fever, or if the abdominal pain does not subside with painkillers and antispasmodics, the possibility of gall bladder inflammation is also raised.
Some patients with gallstones are asymptomatic. However, removal of the gallbladder is still recommended to prevent further complications.
Recommended when typical symptoms appear:
In rare cases, CT, MRI, MRCP may be required as an additional investigation.
The sigmoid colon, the last section of the large intestine. Diseases of the colon include benign or malignant tumours and recurrent inflammation of pouches (diverticula) in the bowel wall, which require surgical intervention.
The sigmoid colon is a tubular organ located between the descending colon and the rectum. The intestinal segment is involved in digestion only through the reabsorption of water and the exchange of ions. There is no significant deterioration in quality of life following removal of the intestinal tract. The length of the sigmoid colon varies. In some sections, the sigmoid colon is located close to the bladder.
A common benign structural disease of the sigmoid colon is the development of sigmoid diverticula. The cause of the disease is not known. It may be due to slowed bowel function and higher bowel pressure due to wind and faecal retention. The latter causes small ‘hernias’ to form along the blood vessels that feed the intestinal wall, creating glove finger-like protrusions in the thinned intestinal wall, called diverticula.
In the latter, bacteria-rich faeces stagnate, causing inflammation. Inflammation alone does not mean that the sigmoid colon should be removed. Surgery is mainly used to prevent complications caused by recurrent inflammation.
Diverticulosis of the sigmoid colon is mainly a disease of the elderly population, but it also occurs at a younger age and is mainly caused by hereditary factors.
In the majority of cases, sigmoid diverticulosis is diagnosed during an examination for left lower abdominal pain. It is characterised by hard, berry-like stools or bloody stools. Diverticulosis requires mainly gastroenterological treatment and follow-up.
Diverticulitis occurs against a background of marked, persistent left lower abdominal pain. Fever, loss of appetite and “raspberry jelly” stools are common. If the inflammation is prolonged, localised or diffuse peritonitis causes high fever and pain throughout the abdomen.
A fistula between the bladder and the sigmoid colon is characterised by recurrent urinary tract infections which are difficult to treat, the presence of faeces in the urine and the passing of gas in the urine
Left lower abdominal pain on the left side of the abdomen:
In acute inflammation, colonoscopy is not recommended. However, it is essential before surgery at a selected time to rule out any underlying malignancies.
If a fistula between the bladder and the intestinal wall or between the vagina and the intestinal wall is suspected, a urological and gynaecological examination is recommended.
Surgical intervention may be needed for inflammatory, benign and malignant tumours of the colon. In the case of inflammatory bowel diseases (Crohn’s disease, ulcerative colitis), regular and detailed gastroenterological examinations and treatment are the mainstay, but there may be cases where partial or total removal of the colon is necessary.
Benign colorectal diseases are polyps, polyposis syndromes of various localisation, which, like inflammatory bowel disease, may require partial or total colon removal. Malignant tumours of the colon are common malignancies which, in their initial stages, are particularly well treated by a combination of surgical, oncological and radiotherapeutic methods.
The large intestine (colon) is the section of our digestive tract between the small intestine and the rectum, which is located in an inverted U-shape in the abdominal cavity, divided into the cecum (with its attached wormhole), the ascending, the descending and the haricot sections, and the sigmoid colon. It is in this section of the intestine that the final phase of digestion, the reabsorption of water and the exchange of ions, takes place and where the faeces are formed.
The exact cause of inflammatory bowel disease is currently unknown. The exact causes of Crohn’s disease and ulcerative colitis are not yet known. The long-term presence of the former diseases and the maintenance of chronic inflammation promote the development of malignant colorectal tumours, for which surgical interventions are absolutely essential for prevention and treatment. In the case of Crohn’s disease, untreated strictures or fistulas may require surgery.
Benign tumours of the large intestine, polyps, are mainly detected by colonoscopy. They are important because 60-65% of malignant colorectal cancers develop from polyps.
Malignant tumours can develop anywhere in the colon. They are mainly tumours originating in the mucosa of the colon (adenocarcinomas), which over time metastasise to the lymph nodes responsible for the lymphatic circulation in that part of the colon and then to distant organs. The sooner a tumour is discovered and removed, the less likely it is to metastasise.
Surgery involves removing the affected section of the bowel as well as the lymph nodes and lymphatic vessels connected to it. This allows us to get an accurate picture of the stage of the tumour during histological processing.
Contrary to popular belief, a large proportion of benign and malignant tumours do not cause pain, especially in the early stages. Nerve spread and involvement of nerves may cause pain, in which case the tumour may be at a later stage.
