Gallbladder Perforation: A Prospective Study of Its Divergent Appearance and Management

Abstract

Introduction: Gallstone disease is one of the most common surgical diseases. Complications associated with cholelithiasis is not uncommon, but gallbladder perforation is a rare complication of acute cholecystitis with cholelithiasis. This gallbladder perforation may present in different ways like free perforation inside peritoneal cavity causing generalized peritonitis, localized collection around gallbladder fossa after perforation and in chronic cases cholecystoenteric fistula. Here we present our experience of this condition with a review of literature for a different presentation of this condition. Materials and methods: This study was done for 2 years, and patients who were diagnosed with gallbladder perforation either preoperatively or intraoperatively were included. Results: There was a total of 16 patient included in the study during this period which were either diagnosed preoperatively or intraoperatively of gallbladder perforation (GBP). Conclusion: GBP, though a rare complication of cholecystitis with high morbidity and mortality, has no specific pathognomic feature and is often misdiagnosed or late diagnosed. Nowadays most cases can be managed with improved diagnostic means and therapeutic modalities (endoscopic, laparoscopic, endostaplers). IntroductIonG allbladder perforation (GBP) is a rare yet potentially fatal condition occurring as a complication of cholecystitis (calculous or acalculous). The clinical presentation of GBP may not be different from uncomplicated acute cholecystitis, or at times its presentation may perplex the clinician. The clinical features of GBP may vary from that of peritonitis to acute cholecystitis. The mortality rate of GBP is reported to be 12-16%. 1 Acute cholecystitis, calculus, or acalculous, can lead to GBP in 6-12% of cases. 2,3 There are many classifications proposed for GBP, but Niemeier classification is most commonly used. In 1934, he categorized GBP perforation in 3 types, type 1 (acute)-it manifests as generalized peritonitis, type 2 (subacute)-localization of fluid at the site of perforation with pericholecystic abscess and type 3 (chronic)-internal (bilio enteric) or external (cholecysto cutaneous) fistula. 4 Here we present our experience of this condition with variable presentation and poorly understood etiology, which is often diagnosed late resulting in high morbidity and mortality rate; dealt by us over a period of 2 years in our institute. The different clinical presentations and its management along with a brief review of the literature available are done in this study. MAterIAls A n d M e t h o d sThis study was done over a period of 2 years and patients who were diagnosed with gallbladder perforation either preoperatively or intraoperatively were included. The clinical presentation, demographic profile, investigations, and management done was recorded. The different possible etiological factors associated with GBP are also discussed. resultsThere was a total of 16 patient included in the study during this period which were either diagnosed preopera...

Minimally invasive approach in a rare emergency surgery, gallbladder perforation

“…At their initial presentation to the Emergency Department, 34 (80.95%) patients complained of abdominal pain, 18 (42.85%) of vomiting, and 16 (38.09%) had a fever (> 38 °C). The presenting complaints of gallbladder perforations include abdominal pain, nausea, and vomiting [ 3 ]. Krishnamurthy et al [ 11 ] found abdominal pain was the most common presenting symptom in 93.9% of patients.…”

“…Among surgical emergencies involving the gallbladder, perforation cases have higher morbidity and mortality rates, and preoperative evaluation is difficult for surgeons because of their rarity [ 1 – 3 ]. Niemeier published a classification system in his study on gallbladder perforations.…”