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Abstract This study included 30 patients with chronic calcular cholecytitis These cases were examined clinically, radiologically, and managed by cholecystectomy The stones were studied for physical characters The incidence of gall bladder stone disease was about 8 % from all surgical cases admitted to the hospital Clinical picture: Age: Most common in age group (30-39) then (40-49), together constituting 65% of the cases, this is followed by (50-59), finally above 60 years. Sex: The female to male ratio was 3 : 1 The cause of high incidence in male is due to racial causes, bilharziasis affecting the liver function, and could be falacious, as females in upper Egypt don’t consult there doctors except rather late. Parity: There were one case nullipara, there were 15 cases less than 5 deliveries and 6 cases more than 5 deliveries Duration of symptoms: Before presenting for treatment usually patients had the symptoms for (3 months -8 years). the causes of delay in the presentation of patient for medical treatment explained by the fact that dyspepsia is common among egyptions due to dietary indiscretion, chronic colitis, etc. Symptoms: Site of pain: Most common in rt hypochondrium then the epigastric region Nature of pain : Colicy in nature in (65% of cases examined) caused by either spasm of the cystic duct or small stones that had been expelled or dull aching in (73 % of cases examined) There is association between two types of pain in some cases Pain is more common with big stones Dyspepsia: Present in 93 % of cases. this dyspepsia explained by the disturbed gall bladder function of bile concentration and contraction in responding to fatty meals Nausia and vomiting : Usually accompanied the biliary colic and may be continue after its disappearance Jaundice as a past history: Some cases noticed to be jaundiced due to: impacted big stone in Hartmann”s pouch , others due to small stones that slip through the common bile duct Some of these cases missed as infective hepatitis Acute cholecystitis and pancreatitis: Some patients had a history of acute attack of cholecystitis or pancreatitis Other symptoms: 6 cases (20%) have suffering from constipation, diarrhea, distenstion and flatulence Constipation is due to absence of bile salts that act as astimulant for the intestinal peristalisis The cause of flatulence is due to the disturbed fat and carbohydrates metabolism Physical examination: Murphy’s sign: in 23% of cases Palpable gall bladder: distended as mucocele or pyocele in 13% of cases Operative finding : There were pathological changes that varies with the duration of symptoms and number of stones, these changes include contracted gall bladder, fibrosed and thickening of the wall and adhesions Some cases revealed normal gall bladder with some sort of mild inflammation and some cases revealed acute changes Study of the stones: Number varied from 1 – more than 100 Solitary stone was the most frequent one Shape: round, disc, globular or angular Outer surface: smooth, rough, spiky or mammilated Size: varied from 5mm – 3cm |