Gallbladder Perforation Research Articles

Early versus delayed laparoscopic cholecystectomy for gallbladder perforation

BACKGROUND Gallbladder perforation occurs in 2% to 11% of patients with acute cholecystitis, with associated mortality estimated to be at 12% to 42%. Because of its low incidence, the data on management remain sparse. There is a lack of evidence to suggest whether early or delayed cholecystectomy is superior in the treatment of perforated cholecystitis. We hypothesize that an early definitive operation is associated with decreased total hospital length of stay (THLOS). METHODS Using the National Surgical Quality Improvement Program database from the American College of Surgery, we identified patients who underwent laparoscopic cholecystectomy for gallbladder perforation on an urgent or emergent basis from 2012 to 2021. We divided them into those who underwent early (<2 days from the date of admission to the date of operation) and delayed cholecystectomy (≥2 days from the date of admission to the date of operation). Our primary outcome was the THLOS. We created multivariate regression models to assess for the association of early versus delayed operation and THLOS. RESULTS The THLOS was found to be 2.94 days longer in the delayed group compared with the early group (p < 0.05). In those who did not present with sepsis on admission, the THLOS was noted to be 4.71 days longer in the delayed group compared with the early group (p < 0.05). Early versus delayed operation was not associated with a difference in the postoperative length of stay, 30-day postoperative complications, rate of readmission, and reoperation, regardless of preoperative sepsis status. CONCLUSION Early laparoscopic cholecystectomy for gallbladder perforation is associated with decreased THLOS, and there were no other differences in outcomes compared with delayed laparoscopic cholecystectomy. Patients with gallbladder perforation would likely benefit from an early operation within 2 days of admission. LEVEL OF EVIDENCE Therapeutic/Care management; Level III.

Laparoscopic Management of Spontaneous Gallbladder Perforation in Acalculous Cholecystitis: A Case Series

Laparoscopic Management of Spontaneous Gallbladder Perforation in Acalculous Cholecystitis: A Case Series

Unexpected manifestations of a perforated gallbladder: a case study and imaging assessment

Gallbladder perforation can be caused by delayed diagnosis of cholecystitis and, more rarely, trauma. Despite advancements in imaging modalities, diagnosis is often challenging, leading to further delays in diagnosis and increased morbidity and mortality. In this report, we discuss a 49-year-old Caucasian male who presented to the emergency department with severe, out-of-proportion pain and fevers following a mechanical fall. Blood tests were unremarkable, but portal venous contrast-enhanced CT of the abdomen-pelvis showed a thickened gallbladder with perihepatic fluids, and CT of the chest revealed bilateral lobar atelectasis. After a period of conservative management, the patient eventually underwent diagnostic laparoscopy, revealing a perforated gallbladder with biliary peritonitis.

Formation and rupture of liver hematomas caused by intrahepatic gallbladder perforation: A case report and review of literature

Formation and rupture of liver hematomas caused by intrahepatic gallbladder perforation: A case report and review of literature

A case of Kawasaki disease complicated with gallbladder perforation

A case of Kawasaki disease complicated with gallbladder perforation

EP362 - Small Cell Ca of the Gall Bladder: A rare tumour of the gall bladder

Abstract Small cell carcinoma (SCC) of the gallbladder is an extremely rare tumour. Despite aggressive and varied treatments, its prognosis is poor. A 53/F presented with complaints of pain in abdomen and fever since 3 days. Patient was vitally stable and tenderness present over the epigastric, Right hypochondrium and Right lumbar region. Except leucocytosis, all labs were WNL. CECT Abdomen pelvis was suggestive of suspicious Gall bladder perforation with necrotic lymph nodes in the peri-pancreatic region. The patient was taken for exploratory laparotomy and a perforated gall bladder was seen intra op and cholecystectomy was performed. Histopathology findings were suggestive of small cell carcinoma - gall bladder and IHC markers (Synaptophysin, CD56, Ki67, EMA, CK19) sent for confirmatory findings were raised. Post op PET CT shows periportal, paracaval and aortocaval metastatic lymph nodes. Chemotherapy regimen (cisplatin + itoposide) was started post op and patient is under follow up. The incidence of SCC of the GB is approximately 0.5% of all GB cancers. Among NETs of the gastrointestinal tract, SCC of the GB compromises 0.2%. Less than 100 cases of this tumour have been documented in the English literature. Surgery is the mainstay of GB cancer treatment. Due to poor prognosis of SCC of the GB, even when curative surgery is possible, additional treatment methods such as chemoradiation should be considered.

333. TECHNICAL CONSIDERATIONS IN UPPER-GI RECONSTRUCTION – A CASE SERIES

Abstract Background Oesophageal reconstruction post-oesophagectomy is performed for both benign and malignant pathologies. Generally, the stomach is the conduit of choice due to its simplicity, requiring only one anastomosis. However, in some cases the stomach may not be a viable option immediately or at all, and alternatives must be considered. We describe a case where the stomach was not immediately viable and two cases where alternative conduits were sought. Furthermore, we discuss techniques such as ‘supercharging’ and ‘superdrainage’ which enhance arterial flow and venous drainage respectively, in order to prevent ischaemia and related complications of the anastomosis site. Methods and Results Case 1 presents a 72-year-old with an incarcerated para-oesophageal hernia leading to necrosis of the distal oesophagus and proximal stomach. After resection, a feeding jejunostomy and a loop oesophagostomy in the neck was created. Months later, the oesophagostomy was closed, and the residual stomach was carefully mobilised into the thorax while preserving the gastro-epiploic arcade, and oesophago-gastric anastomosis was performed. Case 2 involves a 68-year-old female who had elective Nissen fundoplication for a hiatus hernia, which recurred early with strangulation of the distal oesophagus and proximal stomach requiring emergency oesophago-gastrectomy. She later underwent a colonic interposition using the left colon, with superdrainage through an anastomosis between a branch of the middle colic vein to the left external jugular vein. Case 3 describes a 61-year-old male with a gastro-oesophageal adenocarcinoma treated with an Ivor-Lewis oesophagectomy. A year later, he suffered from a strangulated diaphragmatic hernia causing necrosis of the gastric conduit. This was replaced with an isoperistaltic colonic interposition using the transverse and left colon with super drainage. Unfortunately, three years later, this was again complicated with pancreatitis and perforated gall bladder with associated ischaemia of the colonic conduit. A re-do of the colonic interposition using the right colon was done with an arterial graft between the right transverse cervical artery and branch of ileal artery and super drainage via a branch of the ileal and right external jugular veins. Conclusion Primary and in particular secondary re-constructions of the UGI tract are complex procedures and individual approaches are needed as residual anatomy varies. Consequently, such cases require meticulous planning and a multidisciplinary approach involving the cardio-thoracic, plastic and vascular surgeons and adequate support by the anaesthetic and intensive care team. Although associated with significant morbidity and mortality, reestablishment of a swallowing passage is often desired by patients to maintain quality of life.

Gall Bladder Perforation: An Unusual Cause of Elevated CA19-9 Levels

Gall Bladder Perforation: An Unusual Cause of Elevated CA19-9 Levels

No significant persistent symptoms from gallstones left in the abdomen after cholecystectomy

IntroductionPerforation of the gallbladder during cholecystectomy can lead to spillage of gallstones. The aim of this study was to examine if patients with gallstones left in the abdomen after cholecystectomy suffer persisting symptoms. MethodThis study was based on data from the Swedish Register for Gallstone Surgery. Patients with intraoperative gallbladder perforation where it is suspected that gallstones remain in the abdomen were matched with patients that had undergone a cholecystectomy with no suspicion of spilled gallstones. All patients were sent a validated questionnaire including 21 items concerning abdominal pain and inflammatory symptoms. Items were divided into four groups: abdominal pain, consequences of pain, gastrointestinal symptoms, and repeated operation. Mean scores were compared between the study group and the control group using a linear regression model. ResultsThe questionnaire was sent to 4269 subjects, and the response rate was 66 %. No significant differences were seen between the study and control groups in the four domains. In the repeated operation domain, 7.1 % in the study group and 5.3 % in the control group underwent a repeated operation (p = 0.057). ConclusionGallstones left in the abdomen are not associated with long-term symptoms. There was a tendency towards a repeat operation in the group that suffered perforation of the gallbladder, although this finding was not significant.

Gallbladder Perforation as a Complication of Enteric Fever: An Intriguing Case of Acute Abdomen

If not identified and treated right once, gallbladder perforation—a uncommon but dangerousconsequence of acute cholecystitis—can result in significant morbidity and mortality. We describe theexample of a female patient, having 19 years of age, who had a history of constipation. The patient was diagnosed with typhoid fever and underwent imaging studies that revealed gallbladder wall perforation along its postero-inferior aspect with adjacent contained right subhepatic collection. The patient underwent diagnostic laparoscopy and subtotal cholecystectomy. This instance emphasizes how crucial it is to rule out gallbladder perforation while diagnosing acute abdomen in typhoid fever patients. Prompt surgical intervention and early diagnosis can avert major problems and enhance results.

Minimally invasive approach in a rare emergency surgery, gallbladder perforation

BackgroundGallbladder perforations are challenging to manage for surgeons due to their high morbidity and mortality, rarity, and surgical approach. Laparoscopic cholecystectomy (LC) is now included with open cholecystectomy in surgical managing gallbladder perforations. This study aimed to evaluate the factors affecting conversion from laparoscopic to open cholecystectomy in cases of type I gallbladder perforation according to the Modified Niemeier classification.MethodsPatients who met the inclusion criteria were divided into two groups: LC and conversion to open cholecystectomy (COC). Demographic, clinical, radiologic, intraoperative, and postoperative factors were compared between groups.ResultsThis study included 42 patients who met the inclusion criteria, of which 28 were in the LC group and 14 were in the COC group. Their median age was 68 (55–85) years. Age did not differ significantly between groups (p = 0.218). However, the sex distribution did differ significantly between groups (p = 0.025). The location of the perforation differed significantly between groups (p < 0.001). In the LC group, 22 patients were perforated from the fundus, four from the trunk, and two from the neck. In the COC group, two patients were perforated from the fundus, four from the trunk, and eight from the neck. Surgical procedure times differed significantly between the LC (105.0 min [60–225]) and COC (125.0 min [110–180]) groups (p = 0.035). The age of the primary surgeons also differed significantly between the LC (42 years [34–63]) and COC (55 years [36–59]) groups (p = 0.001).ConclusionsLC can be safely performed for modified Niemeier type I gallbladder perforations. The proximity of the perforation site to Calot’s triangle, Charlson comorbidity index (CCI), and Tokyo classification are factors affecting conversion from laparoscopic to open surgery of gallbladder perforations.

Assessment of Early Laparoscopic Cholecystectomy in Management of Acute Calcular Cholecystitis

Abstract Background Acute cholecystitis is one of the most significant diseases in the Western world and has a high socioeconomic impact. Mainly, patients with gallstones and older adults are affected. The main complication of acute cholecystitis is recurrent biliary colic and cholestasis. The latter may lead to ascending cholangitis, and while this can be managed with antibiotics, other complications cannot be cured conservatively such as gangrenous changes, gall bladder perforation and biliary leakage, and acute necrotic gallstone pancreatitis. Liver abscesses and underlying incidental carcinoma have also been reported in some cases. Aim of the Work The purpose of this study is to focus on success rate of early laparoscopic cholecystectomy as a management of acute calcular cholecystitis along with its operative and post- operative outcomes. Patients and Methods This is a prospective cohort study conducted on forty (40) patients presenting to Ain-Shams University hospitals and authorized hospitals presented with acute calcular cholecystitis starting from January 2021 and December 2021. Results Our study demonstrates that in terms of morbidity and mortality, early laparoscopic cholecystectomy is safe, feasible and cost-effective for cases of acute cholecystitis. The outcome of the patients in our study provides further evidence that early laparoscopic cholecystectomy can be performed within the first 72 hours of symptoms with no significant increase in length of operation. Moreover, there was no significant increase in the rate of major intra operative or post operative complications such as bleeding, bile duct injury, bowel injury, wound infection and conversion to open cholecystectomy. The major advantage of early cholecystectomy was that early laparoscopic cholecystectomy allows significantly shorter total hospital stay and reduction in days away from work. Moreover, it avoids repeated admissions for recurrent symptoms. Conclusion Early laparoscopic cholecystectomy is safe, feasible and cost-effective for cases of acute cholecystitis and its major advantage is that it allows significantly shorter total hospital stay and reduction in days away from work and avoids repeated admissions for recurrent symptoms.

Gallbladder perforation during endoscopic internalization of percutaneous cholecystostomy tube: lessons learned

Gallbladder perforation during endoscopic internalization of percutaneous cholecystostomy tube: lessons learned

Avoidance of bile duct injury in laparoscopic cholecystectomy with feasible intraoperative resources: A cohort study.

Laparoscopic cholecystectomy (LC) is one of the most commonly performed surgeries and is considered the standard treatment for cholelithiasis. However, it is associated with a risk of bile duct or hepatic artery injuries. This study evaluated the safety of LCs and the conversion rate (CR) by achieving a critical view of safety (CVS) and identification of Rouviere's sulcus (RS). This was a single-group cohort study that included consecutive patients undergoing LC at Smart Health Tower (Sulaimani, Iraq) from January 2021 to January 2023. The data were prospectively collected from patients' profiles or surgical notes within the hospital's database. A total of 419 patients underwent LC, of which females were the predominant gender (78.5%). The mean and median ages of the cases were 46.3±15.8 and 45 years, with a range of 2-90 years, respectively. The most common indications for surgery were biliary colic (69.5%), followed by acute cholecystitis (23.9%). The duration of the operations was significantly shorter for cases in which the CVS (45.6±17.9 min) or identification of RS (45.6±18.6 min) was achieved compared to those where the CVS (63.7±27.7 min) or RS (50.7±21.7 min) was not observed. Surgeries for patients with both CVS achievement and RS identification were also significantly less time-consuming (44.3±17.6) than counterparts (53.3±22.6). Among the cases without CVS achievement or RS identification (n=97, 23%), eight (8.2%) had adhesions, 12 (12.4%) had a distended gallbladder (GB) and 10 (10.3%) had thick GB walls. In addition, four (4.1%) experienced GB perforation, two (2.1%) had bleeding and one (1%) had stone spillage. There was no conversion. The achievement of CVS and identification of RS are practical landmarks in performing safe LC and decreasing the CR.

Endoscopic Closure of Duodenal Perforation using Intracavitary Endoscopic Negative Pressure Therapy

Regardless of the cause of a duodenal perforation, operative treatment remains a fundamental therapeutic choice. The endoscopic closure of leaks is helpful only for fresh defects without an accompanying infection and is limited by the size of the defect. However, the operative treatment of duodenal perforations in the population of older and multimorbid patients is associated with a high morbidity, as well as mortality. Here, we describe a successful case of an endoscopic closure of a duodenal perforation in the bulbus using intracavitary endoscopic negative pressure therapy in a 68-year-old patient initially operated because of an acute cholecystitis with focal gallbladder perforation involving the duodenal wall. Over the course of time a secondary perforation of the duodenum was diagnosed, and a reoperation with a suturing of the duodenum did not lead to complete closure of the defect. Three weeks of intracavitary endoscopic negative pressure therapy led to the successful closure of the duodenal defect. This type of therapy can be an excellent alternative to surgery, for treating duodenal perforations in selected patients.

Unusual case of Niemeier type II gallbladder perforation: case report and literature review.

Niemeier type II gallbladder perforation (GBP) is caused by inflammation and necrosis of the gallbladder wall followed by bile spilling into the abdominal cavity after perforation. The gallbladder then becomes adhered to the surrounding inflammatory tissue to form a purulent envelope, which communicates with the gallbladder. At present, the clinical characteristics and treatment of type II GBP are not well understood and management of GBP remains controversial. Type II GBP with gastric outlet obstruction is rare and prone to misdiagnosis and delayed treatment. Recent systematic reviews report that percutaneous drainage does not influence outcomes. In this current case, due to the high risk of bleeding and accidental injury, as well as a lack of access to safely visualize the Calot's triangle, the patient could not undergo laparoscopic cholecystectomy, which would have been the ideal option. This current case report presents the use of percutaneous laparoscopic drainage combined with percutaneous transhepatic gallbladder drainage in a patient with type II GBP associated with gastric outlet obstruction. A review of the relevant literature has been provided in addition to a summary of the clinical manifestations and treatments for type II GBP.

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.

EVALUATING THE EFFECTIVENESS OF THE CRITICAL VIEW OF SAFETY IN LAPAROSCOPIC CHOLECYSTECTOMY AT BINH DAN HOSPITAL

Background: The aim of this study was to assess the safety of laparoscopic cholecystectomy using "The Critical View of Safety" (CVS) technique for the management of gallbladder stone disease. Subjects and methods: Prospective study, describing a series of cases of patients undergoing laparoscopic cholecystectomy with CVS applied to treat gallbladder stones at Binh Dan Hospital from January 2022 to October 2022. Results: We enrolled 89 patients and recorded the following outcomes: the success rate was high, at 97.8%. The failure cases were due to large stones blocking the gallbladder neck and severe adhesions in the hepatocystic triangle in necrotizing cholecystitis. There is a statistically significant difference in the success rate of achieving CVS between groups: gallbladder condition (p=0.02), degree of adhesion inflammation of the hepatocystic triangle (p=0.039). The overall bleeding complication rate was 10.3% (9 cases) and during CVS was 6.7% (6 cases). The overall gallbladder perforation complication rate was 8% (7 cases) and during CVS was 4.4% (4 cases), with no biliary tract injuries. The postoperative complications included fluid collection in the gallbladder bed in 10.3% of cases and surgical wound infection in 2.3% of cases. All were successfully treated with conservative measures. Conclusion: We concluded that CVS is a necessary, safe, and effective diagnostic method in laparoscopic cholecystectomy for gallbladder stone disease.

Most common complications related to cholecystectomy: a systematic review

Cholecystectomy is one of the most commonly performed surgical procedures worldwide, indicated for cases of cholecystitis, cholelithiasis, biliary pancreatitis, or biliary neoplasms. During the procedure, factors such as variations in bile ducts, gallbladder topography, and vessels increase the risk of complications. The objective of the study is to discuss the most common complications related to cholecystectomy, based on a systematic review of original papers obtained from SciELO, PubMed, and BVS databases published between 2019 and 2024. The most commonly associated complications with this procedure are bile duct injury, biliary fistula, biliary stenosis, abscess formation, vessel injuries, gallbladder perforation, and abscess formation. Management of these complications depends on their type and severity. It was concluded that the most frequent complication was bile duct injury, which was more associated with laparoscopic technique.

Simulation training of intraoperative complication management in laparoscopic cholecystectomy for novices—A randomized controlled study

BackgroundIntraoperative complications occur more often in laparoscopic cholecystectomies (LCs) than in open cholecystectomies. Since LC is a frequent training procedure, surgical residents should be trained to deal with intraoperative complications in a safe and controlled environment. This study aimed to determine whether structured training in coping mechanisms in complication management in LC benefits novices compared to no training in complication management. MethodsThe study included sixty medical students without prior experience in minimally invasive surgery. They were randomly assigned to the intervention or control group and worked in teams of two. Both groups completed multimodal skill training, including one ex-vivo porcine LC. The intervention group (n=30) was then informed about the complications that can occur during an LC and how to manage them using the Coping Mechanisms for Intraoperative Complication Management in Laparoscopic Cholecystectomy (COMIC-LC) tool specially developed for this study. Afterward, they performed two LCs receiving structured training in coping mechanisms for intraoperative complication management. The control group (n=30) performed two LCs, receiving no information about managing complications. Both groups performed two postinterventional LCs. Complication management of the two groups was evaluated using the COMIC-LC assessment score. ResultsThe intervention group demonstrated better management of intraoperative complications in LCs compared to the control group (gallbladder perforation: 8.5 vs. 3.0 points, p<0.001; injury to the liver parenchyma: 7.0 vs. 2.0 points, p<0.001; cystic artery injury: 8.0 vs. 5.0 points, p<0.001; cystic duct injury: 6.0 vs. 1.0, p<0.001). ConclusionStructured training in coping mechanisms for managing intraoperative complications during LC can improve complication handling and potentially reduce adverse events. Translation to clinical practice should be evaluated.