Gallbladder perforation and bile leakage: diagnosis by colour Doppler sonography and percutaneous treatment

Abstract

Nowadays, ultrasound examination is routinely utilized in the diagnosis of acute cholecystitis and its complications. Perforation of the gallbladder wall is usually suspected from indirect, non-specific sonographic findings, i.e. pericholecystic fluid collections, free peritoneal fluid, irregular gallbladder wall thickening, gallbladder distention, gallstones, coarse intracholecystic echogenic debris, and a complex mass in the gallbladder fossa (Forsberg et al, 1988; Chen et al, 1990). Sonographic visualization of the gallbladder perforation itself is rarely achieved (Chau et al, 1988; Takada et al, 1989; Chen et al, 1990). We report a case in which colour Doppler sonography allowed direct visualization of the biliary leakage across the gallbladder wall, thus providing the diagnosis. In addition, percutaneous catheter drainage of both the gallbladder and adjacent collection allowed the perforation to heal, hence avoiding surgery.

Sonographic diagnosis of gallbladder perforation.

“…The third sign is the detection of calculi within the perihepatic collection, indicating that gallbladder rupture has occurred. 4,9 In our case, calculi were noted free in the peritoneal cavity.…”

Current management of gall bladder perforations

“…This problem presents a challenge to the surgeon due to delay in recognition, difficulty in diagnosis and associated high morbidity and mortality 3,4 . A number of improvements have been made in the recognition and management of this complication in the last two decades leading to a decrease in the mortality figures 5,6 . Niemeier classified gall bladder perforations into three categories 7 .…”

Septated Ascites and Cholelithiasis

“…Identification of calculus within a perihepatic collection is also a sign of gallbladder rupture. 5,6 Septated ascites represents an unusual finding of gallbladder perforation and in this case resulted from the perforation combined with the extensive surgery in the remote past.…”