Abstract
IntroductionGallbladder perforation is a rare but life threatening event. We describe a case of gallbladder perforation encountered at initial presentation.Case presentationA 51 years old male, without any known medical co-morbidity, presented with a 1-day history of sudden-onset abdominal pain and abdominal distension. On examination, his abdomen was distended with generalized tenderness on palpation. Abdominal x-ray showed no signs of intestinal obstruction or pneumoperitoneum. Computed tomography scan of the abdomen showed appearance suggestive of gallbladder perforation. The patient was taken to the operating room and a diagnostic laparoscopy was performed revealing yellowish green fluid in the peritoneum. Difficulty in visualization of the anatomy led to conversion of the procedure to an open laparotomy. Intra-operative findings included a perforation near the neck of the gall bladder in association with a 2 × 1 cm gall stone. Near-total cholecystectomy was performed and a single large gall stone was retrieved. The peritoneal cavity was washed with normal saline and a drain was placed. The rectus sheath was closed but the wound was kept open for healing by delayed primary closure. The patient's hospital course was uneventful and he was discharged from the hospital on the 3rd post-operative day. He returned to the clinic after one week whereby his drain was removed and his wound closed.ConclusionGallbladder perforation is an unusual initial presentation of gallbladder disease. Early diagnosis of gallbladder perforation and immediate surgical intervention are of prime importance in decreasing morbidity and mortality associated with this condition.
Highlights
Gallbladder perforation is a rare but life threatening event
Diagnosis of gallbladder perforation and immediate surgical intervention are of prime importance in decreasing morbidity and mortality associated with this condition
Gallstone ileus, cholecystoenteric fistula, emphysematous cholecystitis, gallbladder perforation and biliary peritonitis are among the severe complications of acute calculous cholecystitis
Summary
Gallstone ileus, cholecystoenteric fistula, emphysematous cholecystitis, gallbladder perforation and biliary peritonitis are among the severe complications of acute calculous cholecystitis These complications are associated with increased morbidity and mortality [1], and can develop at a high rate if the condition is left untreated. We report here the case of a 51 years old gentleman who presented with acute free perforation of the gall bladder and associated biliary peritonitis in the absence of any previous clinical episodes of acute cholecystitis. His vital signs were stable except for an increased pulse of 105 beats per minute Examination of his respiratory system revealed vesicular breathing with decreased intensity of breath sounds in the right lung base as well as dullness on percussion on the right side of the chest. The patient's emergent management included nothing per oral status, regular vitals and input/output charting, insertion of nasogastric tube, administration of intravenous fluids, narcotic analgesics, proton pump inhibitors, metochlopramide, ceftriaxone, metronidazole, and ampicillin
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