Abstract
Gall bladder perforation is a rare but life-threatening complication of acute cholecystitis.1 Two per cent of patients undergoing cholecystectomy are found to have perforation of the gall bladder. It occurs in 10% of patients who are being treated conservatively.2 Most studies in which the patients are generally aged 60 or more. Studies reported a mortality rate of 42%, others have reported mortality to be between 12 and 16%.3,4,5 Due to the high mortality that can be caused by a delay in the correct diagnosis and following adequate surgical treatment, gallbladder perforation represents a special diagnostic and surgical challenge.6 Most cases can only be diagnosed during surgery7,8,9. We report one such case which was diagnosed as gall bladder perforation.
Highlights
Gall bladder perforation is a rare complication of cholecystitis
Larmi et al[10] and Addison and Finan[11] advocated early and urgent cholecystectomy for acute gall bladder disease. They reported the risk of perforation to be between 3 and 12% in patients treated conservatively for acute cholecystitis
They showed that the mortality and morbidity for emergency cholecystectomies compared favourably with those for elective surgery and concluded that in well selected patients, emergency cholecystectomy for acute cholecystitis should be advocated as a safe procedure
Summary
1. Case report: A 60 year old man presented with a two day history of acute severe epigastric pain. Examination showed board-like rigidity in the upper abdomen with considerable tenderness. No free gas was seen under the diaphragm on the chest X- ray but shows pleural effusion on right side. Ultrasound abdomen revealed mild to moderate ascities. On entering the peritoneal cavity, about 1 litres of bile was drained and a gangrenous gall bladder was seen with omentum stuck to its fundus where it had perforated.(Fig 2,3 & 4)
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