Gangrenous Gallbladder Perforation: Varied Presentation, Management, and Treatment Outcome

Abstract

Abstract Introduction: Gangrenous cholecystitis (GC) is a serious complication associated with cholecystitis and usually presents with greater mortality than uncomplicated cholecystitis. It may be associated with cholelithiasis or can be due to acalculous cholecystitis. Acalculous cholecystitis is usually associated with elderly age and or associated with comorbidities such as diabetes mellitus (DM), coronary artery disease, and chronic debilitated bedridden patients. Since these patients are elderly, have other symptomatology of chronic illnesses, and usually suffer from peripheral neuropathy, the diagnosis can be missed in initial stages. We present here a case series of five patients with GC who presented in whom the diagnosis was missed initially and subsequent surgical intervention resulted in rapid recovery. Material and Methods: The aim of this study was to emphasize on the importance of keeping index of suspicion and early surgical intervention in such cases to prevent morbidity and mortality. Patients studied in this case series were initially admitted to the medical ward and surgical consult was sought later. Delay in seeking surgical consult ranged from 1 to 4 days. All of them underwent cross-sectional imaging in form of contrast-enhanced computed tomography abdomen and subsequent open cholecystectomy based on imaging findings of perforated gallbladder, intraoperatively these patients were found to have perforated gallbladder secondary to GC. Results: Out of the five patients studied, 3 (60%) were female and 2 (40%) were male, with a mean age of 64.5 (55–73) years. DM constitute most frequently accompanying medical issues (80%). Surgical site infection was seen as the most common postoperative complication. Longer delay time before diagnosis was determined as independent risk factor affecting morbidity and mortality.