Acute Gallbladder Perforation Research Articles

Early laparoscopic cholecystectomy in acute gallbladder perforation: Single-centre experience.

Background:Acute gallbladder perforation (GBP) is associated with significant mortality and morbidity. Percutaneous drainage followed by interval cholecystectomy has been the preferred management. The outcomes of early surgery, especially by laparoscopy, have not been well studied in GBP. We present our experience in early laparoscopic cholecystectomy in GBP.Methodology:A retrospective analysis of patients admitted with GBP between April 2014 and December 2018 was done. Clinical presentation, preoperative imaging, surgical procedure, operative findings and the outcomes in these patients were analysed. Video of the surgeries was reviewed in case of the absence of data from the case records.Results:Fifteen patients were treated for GBP during the study period. Eleven patients were male, and the mean age was 61 years. Fourteen patients (93.3%) had associated co-morbidities. Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock were present in 3, 3, 6 and 3 patients, respectively. The location of the collection was gallbladder fossa, pericholecystic, subhepatic and diffuse in 3, 5, 4 and 3 patients, respectively. Intraoperatively, 13 patients were detected to have perforation at the fundus of the gallbladder. Cystic duct stump was managed with clip, endoloop, suturing and external drainage in 7, 2, 5 and 1 patient, respectively. Laparoscopic cholecystectomy was completed in 12 (80%) patients. Retroinfundibular technique was used in 12 (80%) patients. There was one conversion. Two patients required endoscopic retrograde cholangiogram + bile duct stenting, and one was reexplored for cystic artery bleed. There were no mortalities. The median duration of post-operative hospital stay and drain removal was 3 (1–19) and 3 (1–6), respectively.Conclusion:Early laparoscopic cholecystectomy in acute GBP is feasible and can be safely performed in centres having sufficient expertise. Retroinfundibular technique of laparoscopic cholecystectomy is useful in tackling frozen Calot's triangle in GBP.

Acute gall bladder perforation: case series over three years

Background: Acute perforation of gall bladder is a life threatening condition. It is a complication of acute cholecystitis. This is not an uncommon condition and resembles acute cholecystitis in its presentation. If there is delay in diagnosis and management there is high morbidity and mortality. It should be diagnosed as early as possible for better prognosis.Methods: This is a retrospective study wherein data of cholelithiasis, acute and chronic cholecystitis and perforated gall bladder from our hospital for the last three years 2014-2016 was collected. The clinical presentation, investigations routine and radiological, surgical and medical management was analysed.Results: Total numbers of patients with chronic cholelithiasis were 3534, patients with acute cholecystitis were 133, and numbers of patients with gall bladder perforations were 22, making it 0.6% of gall bladder disease patients and 16.5% among patients with acute cholecystitis. TLC was invariably raised in all the cases. 12 out of 22 cases were managed conservatively while others underwent surgery. There was no mortality in the series.Conclusions: Gall bladder perforation occurs in about two weeks or several weeks after episode of acute cholecystitis, the incidence of occurrence of perforation increases to four folds if there is delay in proper management of acute cholecystitis more than two days after the onset of symptoms. Clinical presentation varies from an acute generalized peritonitis to nonspecific abdominal symptoms and thus requires prompt diagnosis for better prognosis.

Acute gallbladder perforation with gallstones spillage in a cirrhotic patient

Gallbladder perforation is a rare complication of cholecystitis and cholelithiasis. The high morbidity and mortality rates associated with this condition are due to delays in diagnosis and treatment since signs and symptoms of perforation do not differ significantly from those of uncomplicated cholecystitis. We report on a patient who was affected by Child-Pugh A alcoholic liver cirrhosis and who developed an acute gallbladder perforation with spillage of stones into the peritoneal cavity and give a review of the current literature.

Acute gall bladder perforation--a dilemma in early diagnosis.

Gall bladder perforation is a rare complication of cholecystitis. A definitive diagnosis is uncommon before surgery and the morbidity and mortality associated with this condition are high. We report six patients with gall bladder perforation to show the difficulty of making an early diagnosis. The history and the clinical findings of these patients are reviewed to highlight diagnostic pitfalls.

Risk Factors for Perforation of Gallbladder: A Combined Hospital Study in a Chinese Population

The composition and location of gallstones differ in Western and Eastern people. This has been documented in the literature. The difference in the clinical manifestations of biliary calculous disease has been postulated to be based on ethnic or environmental factors. In an effort to improve our management of patients with gallbladder perforations, a combined hospital study in a Chinese population during 11 years was conducted to study the clinical profiles at risk. Seventy-one patients were studied. The perforations were categorized as either acute (type I) in 14 (19.7%), subacute (type II) in 25 (35.2%), or chronic (type III) in 32 (45.1%). The incidence of severe underlying disease was significantly greater (p = 0.02) in patients with acute and subacute perforation as compared with chronic perforation. Multiple stones in the biliary tree and the gallbladder are very common and may mask the presentation of gallbladder perforation when patients with either biliary colic or biliary tract infection. A history suggestive of chronic gallstone disease is common, especially in patients with chronic perforation. The clinical manifestations of gallbladder perforation are similar to those of acute cholecystitis without perforation. On the basis of these data, clinical profiles have been developed for patients at risk of developing acute versus chronic gallbladder perforation. Awareness of these groupings forms the basis for early recognition and treatment of acute gallbladder perforation.

Ultrasonography in acute gallbladder perforation

The files of patients with acute cholecystitis from two large university hospitals from the years 1978-1985 were employed to find the cases with acute gallbladder perforation for this study. Only those patients (n = 9) were selected for the analysis of sonographic signs of acute gallbladder perforation who had less than 48 hours of symptoms before sonography, and were operated upon within 24 hours of the sonography. Patients (n = 10) with non-complicated acute cholecystitis and identical in regard to the duration of the symptoms and the timing of the sonography and the operation formed a control group. The sonographic findings in patients with gallbladder perforation were pericholecystic fluid collections, free peritoneal fluid, disappearance of the gallbladder wall echoes, focal highly echogenic areas with acoustic shadows in the gallbladder, and an inhomogeneous, generally echo-poor gallbladder wall.

Ultrasonography in Acute Gallbladder Perforation

The files of patients with acute cholecystitis from two large university hospitals from the years 1978–1985 were employed to find the cases with acute gallbladder perforation for this study. Only those patients (n=9) were selected for the analysis of sonographic signs of acute gallbladder perforation who had less than 48 hours of symptoms before sonography, and were operated upon within 24 hours of the sonography. Patients (n=10) with non-complicated acute cholecystitis and identical in regard to the duration of the symptoms and the timing of the sonography and the operation formed a control group. The sonographic findings in patients with gallbladder perforation were pericholecystic fluid collections, free peritoneal fluid, disappearance of the gallbladder wall echoes, focal highly echogenic areas with acoustic shadows in the gallbladder, and an inhomogeneous, generally echo-poor gallbladder wall.

Ultrasonography in acute gallbladder perforation

Ultrasonography in acute gallbladder perforation

Anomalies of the Bile Passages combined with Acute Gall-bladder Perforation

A 17-year-old man underwent an emergency operation for acute appendicitis. An acute gall-bladder perforation was found with bile in the peritoneal cavity. Operative cholangiography showed segmental dilatations of the intrahepatic ducts, more pronounced in those of the left lobe than the right. Part of the common hepatic duct seemed to be affected also. Only a few cases of this presumably developmental anomaly have been reported, nearly always in association with medullary “sponge kidneys”. The kidneys in our case showed typical changes of this condition. In addition there was absence of the cystic duct, a combination which has not previously been described.