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The Pucker sign: an operative and radiological indicator of impending operative difficulty due to severe chronic contractive inflammation in cholecystectomy
Author(s) -
Strasberg Steven M.,
Bhalla Sanjeev,
Hammill Chet W.
Publication year - 2018
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.583
Subject(s) - gallbladder , medicine , cholecystectomy , contraction (grammar) , computed tomography , chronic cholecystitis , cholecystitis , sign (mathematics) , radiology , surgery , mathematics , mathematical analysis
Marked inflammatory contraction of the gallbladder at the time of cholecystectomy is associated with biliary injury. Methods The evolution of contraction is traced in two patients who developed acute cholecystitis. Results Within months the gallbladder became fibrotically contacted and in doing so pulled the adjacent liver down, puckering the surface of the liver. This puckering could be observed preoperatively on computed tomography and also visually at the time of surgery. Conclusions Puckering of the liver (“Pucker sign”) can alert the surgeon to the presence of severe contractive inflammation.