Case Of Gallbladder Perforation Research Articles

Gallbladder perforation: Diagnostic accuracy of new CT difficulty score in predicting complicated laparoscopic cholecystectomy.

To formulate and evaluate the diagnostic performance and utility of a new CT difficulty score in predicting difficult laparoscopic surgery in cases of gallbladder (GB) perforation. This prospective single centre study included a total of 48 diagnosed cases of GB perforation on CT between December 2021 and June 2023, out of which 24 patients were operated. A new 6-point CT difficulty scoring system was devised to predict difficult laparoscopic approach, based on patterns of inflammation around the perforated GB that were found to be surgically relevant. The pre-operative imaging findings on CT were studied in detail and correlation coefficients of various imaging findings were calculated to predict difficult surgery. On CECT, the type of perforation, according to the revised Niemeier's classification could be exactly delineated in all 48 patients. A CT difficulty score of ≥ 3 was found to a good predictor difficult laparoscopic approach, with statistical significance (p = 0.001), sensitivity of 94.44%, specificity of 83.33%, PPV of 94.44% and NPV of 83.33%. Inflammatory changes around duodenum showed maximum correlation coefficient of 0.744 (p = 0.0001), around colon showed a correlation coefficient of 0.657 (p = 0.0005), and in the omentum had a correlation coefficient of 0.5 (p = 0.013)). Inter-observer agreement was also calculated for various findings and it was found to have moderate to strong agreement (κ value 0.5-1.0). The CT difficulty scoring system can be an effective tool in predicting difficult laparoscopic surgery in cases of GB perforation in an emergency setting which can help in decision making and improved patient outcome.

Gallbladder perforation with biliary peritonitis treated laparoscopically: a case report

Gallbladder perforation (GBP) is a rare yet life-threatening complication associated with acute cholecystitis. This report details a case of GBP accompanied by biliary peritonitis in a 73-year-old male, successfully managed through laparoscopic cholecystectomy. Our case emphasises the critical role of early employment of advanced imaging modalities, such as CT scans, and prompt surgical intervention in these situations to pre-empt potential complications.

Evaluation of Patients with Gall Bladder Perforation: Experience at a Tertiary Centre

Introduction: Gall bladder perforation is a rare but serious complication that presents to our emergency setup. It is usually a sequelae of acute cholecystitis. It requires urgent intervention, failing which mortality can be as high as more than 50%. Neimeier classification of GB perforation has since become the guide to its management. Because of infrequent and rare occurrence of GB perforation the data regarding incidence and management of it is lacking. We present our experience at a tertiary centre of 35 cases of gall bladder perforation that presented to us since January 2020 till June 2022

A retrospective study of diagnosis and management of gallbladder perforation: 10-year experience from a tertiary health care centre.

The aim of this study was to perform retrospective analysis of data collected from patients of gallbladder perforations for diagnosis, management and outcome. A retrospective analysis of data was carried out for 40 patients of gallbladder perforations from the hospital record of patients who were diagnosed preoperatively and intraoperatively as a case of gallbladder perforation over a period of 10 years and were managed in our surgery unit of a tertiary health care centre. Patients were included irrespective of sex except cases of trauma and patients of the paediatric age group. Among 40 patients, 26 were females and 14 were males. As per Anderson modification of Neimeier classification, 13 (32.5%) had type 1, 23 (57.5%) had type 2, and four (10%) patients had type 3 perforations and none of the patients had type 4 perforation. Twenty-three patients (57.5%) were found to have fundal perforation, followed by body in 11 patients (27.5%), three (7.5%) in Hartman's pouch while in three patients (7.5%), there were multiple perforations. All patients of type 1 Neimer classification were diagnosed clinically as cases of biliary peritonitis, whereas most cases of type 2 Neimer classification were diagnosed preoperatively by CECT abdomen 12/23 patients (52%) and ultrasound abdomen 10/23 (43.47%). All patients underwent surgery, and there were three mortalities. In our study, there was female predominance in patients having gallbladder perforation. Of the patients, 52.5% were diabetic and mean age was 55.9 years. CECT abdomen was the most useful modality for diagnosis of type 2 gallbladder perforations. Timely surgical intervention is mandatory for a better outcome of these cases.

Rare Case of Gall Bladder Perforation following acute Calculus Cholecystitis in a Elderly Male: A Case Report

Perforation of the gallbladder is a rare but dreaded complication following cholecystitis.1 Spontaneous perforation is most commonly seen in the elderly, and in patients suffering from diabetes mellitus.2 The most common site of perforation is the fundus of gall bladder.3 The gall bladder distension and edema associated with acute inflammation leads to venous and arterial obstruction. Subsequently, this leads to ischaemia and necrosis of the gall bladder wall. The fundus is most susceptible to this injury due to maximum distance from the cystic arterial supply. Aggravating factors include atherosclerosis, focal vasospasm and localized vasculitis. If diagnosed and treated late, perforation of gallbladder may be associated with high chances of morbidity and mortality.4-6 Here, we report a case of a 66-year-old male with perforation of gallbladder following acute calculous cholecystitis.

DIAGNOSIS AND MANAGEMENT OF GALLBLADDER PERFORATION: A SINGLE-CENTER EXPERIENCE

Background: Gall bladder perforation is one of the uncommon serious complications of cholelithiasis and cholecystitis with high morbidity and mortality. Presentation of gall bladder perforation may vary from that of similar to acute calculus cholecystitis, perforation peritonitis, palpable gall bladder mass to gall stone ileus. Here, we present our experience on the diagnosis and management of the case of gall bladder perforation. Methods: This is the retrospective review of the records of 24 patients who received medical and/or surgical treatment with the diagnosis of gall bladder perforation at Chitwan Medical College from January 2016 to December 2020. All the patients with suspicion of gall bladder perforation underwent contrast enhanced CT scan before an operation or prior intervention.The parameters including age, gender, type of perforation, comorbidities, symptoms, diagnostic procedures, treatment modalities, morbidity, and mortality were evaluated. Results: A total of 24 patients were included in the study during the study period. Among them 62.5% (n=15) were male and 37.5% (n=9) were female.The median age of presentation was 69 years. One patient (4.1%) had type I, 87.5% (n= 21) had type II, and 8.3 % (n=2) had type III gall bladder perforation. CT scan visualizes the defect in gall bladder wall and identifies perforation in all cases. Operative management was done in 12.5% (n=3) patients and percutaneous drainage of gallbladder was done in 87.5% (n=21). The comorbid disease was present in 83.3 % (n=20) of the cases. The median duration of hospital stay was 7 days and there was no mortality. Conclusions: Gall bladder perforation is commonly seen in patients with acute cholecystitis and associated comorbidities. Type II gall bladder perforation is the most common type. Contrast-enhanced CT has an important role in diagnosing gallbladder perforation. Early suspicion, diagnosis, and appropriate management are of crucial importance for a better outcome in patients with gall bladder perforation.

Rare Case of Gallbladder Perforation in Pediatric Patient: A Pitfall in Generalized Peritonitis in Late Presented Typhoid Fever

An 11-year-old boy presented to the emergency room with generalized abdominal pain, inability to pass gas nor stool in 2 days, along with stepladder pattern fever which he had been having in the past 2 weeks before being admitted to the hospital. Abdominal surgical complications are one of most common complications (10-15% of typhoid fever patients) in pediatric typhoid fever, but gallbladder perforation is an uncommon one. Emergency surgical exploration with cholecystectomy was initiated and showed satisfying outcome [1].

Gall bladder perforation after squeeze injury: A Case Report.

Isolated perforation of gallbladder following trauma is very rare and is mainly caused due to distended gallbladder as a result of fasting or alcohol ingestion in normal patients. We report a case of gall bladder perforation caused due to squeeze injury.

2482 Scrotal Gallstones: A Not-So-Silent Gallbladder Perforation With Streptococcus sanguinis Peritonitis

INTRODUCTION: Gallbladder perforation (GBP) is rare and potentially life-threatening. Diagnosis is difficult, and high index of suspicion should be maintained for a patient presenting with cholecystitis. Prompt operative consideration for GBP is recommended. Gallstone disease is more common in patients with cirrhosis, though risk of morbidity and mortality with surgery is often high. We present a case of GBP complicated by peritonitis to illustrate the complexity of managing this condition in a patient with comorbid cirrhosis. CASE DESCRIPTION/METHODS: A 58 year-old man with alcohol-related cirrhosis (Child Pugh C) presented with fatigue, abdominal pain 2 weeks after a large volume paracentesis (LVP), LLQ approach with US. He was afebrile with a distended abdomen, jaundice, and lower quadrant tenderness. Ascitic fluid analysis showed 27 k/μL WBC with 90% neutrophils, initially concerning for peritonitis secondary to bowel perforation from the recent LVP. CT imaging was consistent with gallstones in the pelvic ascites fluid, and a large left hydrocele with stones in the scrotal sac (Figures 1–3). Diagnosis was presumed peritonitis secondary to GBP, though ultrasound and HIDA scan were negative for a gallbladder wall defect or active bile leak. Peritoneal fluid cultures grew Streptococcus sanguinis, and the patient improved with IV antibiotics. Repeat LVP and fluid analysis showed reduced WBC count. Cholecystectomy and peritoneal washout were deferred due to surgical risksin the setting of decompensated cirrhosis. Unfortunately, he developed mixed septic/hemorrhagic shock from a duodenal ulcer bleed and expired shortly thereafter. DISCUSSION: This case exemplifies the complexity in diagnosing and managing GBP in a patient with decompensated cirrhosis. Were it not for his high peritoneal fluid WBC and recent LVP prior to admission, it would be reasonable to suspect spontaneous bacterial peritonitis, CT imaging would be deferred and his GBP unrecognized. Therefore, maintaining high suspicion for GBP in a cirrhotic patient with severe peritonitis or concern for cholecystitis is recommended to avoid complications of GBP. This case also highlights the difficulty in treating GBP, or any symptomatic gallstone disease, in a decompensated cirrhotic where surgery is high risk. This patient's initial stability and decompensated cirrhosis led to deferral of operative consideration, leaving his peritoneal stones as a nidus for infection. His GI bleed was felt to be unrelated, but his septic shock expedited his decompensation.

Nine Cases of Gallbladder Perforation

Nine Cases of Gallbladder Perforation

Comparative Evaluation of Ultrasonography and Cross-sectional Imaging in Determining Gall Bladder Perforation in Accordance to Niemeier’s Classification

Gall Bladder (GB) perforation, a rare but dreaded complication of acute cholecystitis and is associated with high mortality rate. Early detection of acute cases of GB perforation reduces the risk of biliary peritonitis and hence the associated mortality and morbidity. The purpose of the study was to make a comparative evaluation of the role of Cross-sectional imaging in GB perforation with base line investigation like sonography. Finally both modalities were compared in determining the type of perforation according to Niemeier's classification. We retrospectively evaluated the Ultrasonography (USG), Computed Tomography (CT) and Magnetic Resonance Imagings (MRI) findings in patients of GB perforation with surgical correlation. We evaluated 17 patients of GB perforations over a time period of one year. USG was done in all patients. As cross-sectional modality only CT scan was done in 14 patients and MRI scan was done in four patients. Both CT and MRI scans were done in one patient. Cross-sectional imaging must not be delayed in suspected cases of GB perforations because it helps in establishing a quicker diagnosis, detecting complications and also helps in decision making related to management thereby reducing the morbidity and mortality associated with this condition.

A rare case of gall bladder perforation in acute acalculous cholecystitis

Gall bladder perforation is a rare but life threatening complication of acute cholecystitis. It is rarely diagnosed preoperatively, although with a high index of suspicion, awareness, diagnostic procedures such as ultrasound and CT scan scan can help in preoperative diagnosis. However, final diagnosis is usually confirmed at laparotomy. Increase in morbidity and mortality is observed when a definitive diagnosis is delayed [1].

Case series of spontaneous gall bladder perforation and review of literature

Gall bladder perforation in acalculus cholecystitis is a rare condition and has a high mortality rate. A diagnosis before surgery is often difficult. We present two cases of gall bladder perforation encountered at an initial presentation without any clear radiological evidence. A 45 year old male patient, presented with chief complaints of diffuse abdominal pain since 1 day. No other complaints/symptoms were found on a detailed history. Exploratory Laparotomy of this patient, revealed a ruptured gall bladder with necrotic patches and approximately 3 litres of bilious fluid in the peritoneal cavity. Another 45 year old Female, known diabetic, hypertensive and asthmatic presented with diffuse abdominal pain. On laparotomy 2.5 litres of biloma with necrotic gall bladder was observed. Owing to rarity of gall bladder perforation, the condition is often misdiagnosed. Early diagnosis and immediate surgical intervention are the gold standard for decreasing the morbidity and mortality associated with perforation.

A case of gallbladder perforation detected by sonography after a blunt abdominal trauma

Gallbladder (GB) perforation is a very rare posttraumatic abdominal injury. It is potentially life-threatening, and good outcome requires early diagnosis. We present a case of isolated posttraumatic GB perforation in which the precise sonographic (US) diagnosis led us to apply proper management. Color Doppler US showed a clear to-and-fro flow signal passing through the perforation site, and contrast-enhanced US confirmed the presence of a small defect in the GB wall. When examining posttraumatic patients, the possibility of GB perforation must be kept in mind. Color Doppler US and contrast-enhanced US are the examinations of choice to detect the perforation site and show bile movement through the perforation.

English

Introduction Gall bladder perforation is a rare but life threatening complication of acute cholecystitis with or without stones and is associated with increased morbidity and mortality due to late diagnosis. The late diagnosis is attributed to the fact that most of them are present with the same symptoms as in an uncomplicated acute cholecystitis. Most of them are identified and confirmed by laparotomy as preoperative diagnosis is very rare,that is, on computed tomography scan and ultrasound. We are reporting two cases of gall bladder perforation. Case report The first case was a 70-year-old man who was presented to the emergency department with complaints of pain in the abdomen for 7 days and obstipation for 3 days. The second case was a 58-year-old man who was presented to the emergency department with complaints of pain in the abdomen for 1 week and obstipation for 2 days. Conclusion Gall bladder perforation is a fatal and life threatening complication of acute cholecystitis so early diagnosis is the key, as delay will result in the increase of mortality and morbidity.

Gallbladder perforation: the hole sign

We report a case of gallbladder perforation (GBP) in a patient with right upper quadrant pain and a positive Murphy's sign, a previous history of cholelithiasis and co-morbidities. We compare the diagnosis of GBP using the ‘hole-sign’ on ultrasound with the literature for contrast-enhanced ultrasound, computed tomography and magnetic resonance imaging.

著明な腹腔内遊離ガス像を認めた胆嚢穿孔の1例

著明な腹腔内遊離ガス像を認めた胆嚢穿孔の1例

Ruptured gallbladder as the first presentation of breast cancer

BackgroundPerforation of the gall bladder as a first presentation of breast cancer has not been reported.Case presentationHere we present a case of an elderly lady with acute abdomen with evidence of possible perforation of gall bladder on CT scan. Histopathology of the cholecystectomy specimen revealed invasive lobular breast cancer.Her metastatic breast cancer with right sided primary discovered subsequent to her presentation with acute abdomen is managed successfully with Anastrozole.ConclusionWe present a rare case of gall bladder perforation from metastatic breast cancer.

A Case of Gallbladder Perforation Caused by Hemorrhage of the Gallbladder

A Case of Gallbladder Perforation Caused by Hemorrhage of the Gallbladder

Interruption of gallbladder wall with pericholecystic fluid: a CT finding of perforation

In this report, we present an unusual case of gallbladder perforation due to acalculous cholecystitis, masked clinically by acute pancreatitis. Severe abdominal pain referred to the patient's back, nausea, vomiting, and high serum and urinary amylase values were compatible with acute pancreatitis. However, on contrast-enhanced CT, the size and appearance of the pancreas were normal while the gallbladder was abnormally enlarged with a wall defect indicating perforation, soon afterward confirmed by surgery.