Gallstone Disease and Causes for its Late Presentation in Pakistan

Abstract

Background: Gallstones develop among adults with a prevalence rate ranging from 10 percent to 15 percent. Biliary colic and gallbladder distension are caused by obstruction of cystic duct. The cystic duct is obstruction is mainly caused by gallstones impacted at Hartman pouch or stones passing into CBD. If the obstruction persists for longer period, it can lead to mucolceole formation or empyema formation on background of inflammation due cholecystitis. Below the age of 50 years, acute cholecystitis is developed in females three times more than in males. One of the common complications is cholelithiasis is acute pancreatitis which can lead to life threatening complications. Objective: to study gallstone disease and identify the possible reasons for its late presentation in patients. Study design: A retrospective study Place and Duration: This study was conducted at Liaquat University of Medical and Health Sciences Jamshoro Pakistan from December 2021 to December 2022 Methodology: A total of 90 individuals were selected to be a part of this research. All the information related to the patients was collected through a questionnaire. The information includes age, sex, examination findings, and symptoms before the surgery, results, and outcomes after the surgery. All the participants were especially asked why they had arrived at the hospital so late for the surgery. Those records which include symptoms before the surgery, outcomes after the surgery, and complications that the patients faced during the surgery were included. Results: All of the individuals that were a part of this research went under ultrasonography before the surgery which confirmed the presence of cholelithiasis. The time period of the symptoms were falling under the range of six months to fifteen years. More than half of the patients, representing 54.4 percent, were having delayed presentations because they were afraid of anesthesia and afraid to go under surgery. There were also a large number of patients who were not having proper access to the facilities of healthcare because they could not come to the hospital on their own and their husbands were posted far away from their homes. The remaining 5.6% of the patients were those who were misdiagnosed with an acid peptic disease. They went under symptomatic treatment and did not receive proper biochemical and radiological investigations because they were treated in rural settings. Conclusion: The healthcare authorities should promote awareness related to gallstone disease. There should be proper management of dyspepsia where the patients are timely referred and provided with a proper history, examination and investigations.