Gallbladder perforation with fistulous communication

Abstract

BACKGROUND The management of gallbladder perforation (GBP) with fistulous communication (Neimeier type I) is controversial. AIM To recommend management options for GBP with fistulous communication. METHODS A systematic review of studies describing the management of Neimeier type I GBP was performed according to the PRISMA guidelines. The search strategy was conducted in Scopus, Web of Science, MEDLINE, and EMBASE (May 2022). Data extraction was obtained for patient characteristics, type of intervention, days of hospitalization (DoH), complications, and site of fistulous communication. RESULTS A total of 54 patients (61% female) from case reports, series, and cohorts were included. The most frequent fistulous communication occurred in the abdominal wall. Patients from case reports/series had a similar proportion of complications between open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) (28.6 vs 12.5; P = 0.569). Mortality was higher in OC (14.3 vs 0.0; P = 0.467) but this proportion was given by only one patient. DoH were higher in OC (mean 26.3 d vs 6.6 d). There was no clear association between higher rates of complications of a given intervention in cohorts, and no mortality was observed. CONCLUSION Surgeons must evaluate the advantages and disadvantages of the therapeutic options. OC and LC are adequate options for the surgical management of GBP, with no significant differences.

Gallbladder Perforation with Choledochogastric Fistula Due to Ascaris Infestation, a Case Report

“…These complications include the rare spontaneous (non-traumatic) gallbladder perforation (GBP), which has a mortality rate of 12 to 16% and an incidence of 0.8 to 15.0%. 10 According to Neimeier, there are three different types of GBP: type I, which is chronic perforation with fistulous communication; type II, which is subacute perforation with a surrounding abscess that is contained by adhesions; and type III, which is acute perforation and spillage to the cavity with generalized biliary peritonitis. 11 According to Niemeier classification, our patient had type III perforation.…”