Study of Clinico- Epidemiological Profile of Patients with Gallbladder Perforation

Abstract

Background: Gallbladder perforation (GBP) is rare but a potentially fatal disease; its presentation can vary and hence is difficult to diagnose early. It is usually a complication of acute cholecystitis with or without gallstones. Most perforations are subacute, producing a pericholecystic collection. Acute free perforation with biliary peritonitis and chronic perforation with an internal biliary fistula are rare. The fundus of the gallbladder is the most common site of perforation because of its poor blood supply. Material & Methods: This retrospective observational study included all cases of gallbladder perforation that presented to general surgery ward from January 2019 to January 2022. Cases of traumatic gallbladder perforation and gangrenous gall bladder were excluded. The patients were assessed for epidemiological and clinical parameters like age, gender, socio economic status, presenting complaints, history of substance abuse, co- morbidity, hemoglobin, total leucocyte count, renal function tests, liver function tests, history of fever, fever on presentation, pulse, blood pressure and respiratory rate on presentation, type and site of perforation, method of management, diagnostic procedures(ultrasound and contrast CT abdomen findings), duration of hospital stay, and post-operative complications if any were evaluated. Results: This study included 14 patients ( 4 males and 10 females). The mean age of patients was 63.7 years. Gallbladder perforation was most common in the 5th and 6th decade of life. Two Patients had type l perforation and 12 patients had type ll perforation(Neimer’s classification) . Cases were diagnosed on the basis of contrast enhanced CT scan. Patients were managed with carbapenems, intravenous fluids and analgesics . 11(79%) patients were managed conservatively. One patient presented with impending rupture of anterior abdominal wall abscess that was communicating with pericholecystic abscess. Patients on conservative management were managed empirically with Carbapenem antibiotics and recovered well. Two patients underwent cholecystostomy. The mean hospital stay was 11.5 days for conservatively managed group and 18 days for patients who underwent upfront surgery. There was no reported mortality. All patients underwent interval open cholecystectomy after 06 weeks.Mean post operative hospital stay was 4 days in these patients. Each patient was followed up for 06 months in outpatient department and through telecommunication. Conclusion: Gallbladder perforation represents a special diagnostic and surgical challenge. Careful selection and management of patients with broad spectrum antibiotics can help us manage patients conservatively.