Gallbladder perforation

Abstract: AIM: To present our clinical experience with gallbladder perforation cases. METHODS: Records of 332 patients who received medical and/or surgical treatment with the diagnosis of acute cholecystitis in our clinic between 1997 and 2006 were reviewed retrospectively. Sixteen (4.8%) of those patients had gallbladder perforation. The parameters including age, gender, time from the onset of symptoms to the time of surgery, diagnostic procedures, surgical treatment, morbidity, and mortality were evaluated. RESULTS: Seven patients had typeⅠgallbladder perforation, 7 type Ⅱ gallbladder perforation, and 2 type Ⅲ gallbladder perforation according to Niemeier’ s classification. The patients underwent surgery after administration of intravenous electrolyte solutions, and were treated with analgesics and antibiotics within the first 36 h (mean 9 h) after admission. Two patients died of sepsis and multiple organ failure in the early postoperative period. Subhepatic abscess, pelvic abscess, pneumonia, pancreatitis, and acute renal failure were found in 6 patients. CONCLUSION: Early diagnosis and emergency surgical treatment of gallbladder perforation are of crucial importance. Upper abdominal computerized tomography for acute cholecystitis patients may contribute to the preoperative diagnosis of gallbladder perforation.

Abstract: Background: The aim of this study was to identify predisposing factors for complications after gallstone spillage during laparoscopic cholecystectomy (LC). Methods: Papers derived from Medline search and papers from reference lists within these papers were studied. Ninety-one reports on complications caused by lost gallstones published between 1991 and 1998 were analyzed. These patients were compared with cases in published series on LC in general. Results: Gallbladder perforation (20%) and stone spillage (9%) were the two most common complications of LC which occurred during the dissection (75%) and removal (25%) of the gallbladder. Predisposing factors for developing complications after stone spillage were: older age, male sex, acute cholecystitis, spillage of pigment stones, number of stones (>15) or size of the stone (O > 1.5 cm), and perihepatic localization of lost stones. CT-scan and ultrasound examination proved best for the recognition of complications caused by lost stones. Explorative laparotomy and surgical removal of the stones was the most frequently used therapy. Conclusions: Gallbladder perforation and stone spillage might cause hazardous complications. In cases with loss of numerous or large pigment stones which cannot be retrieved by laparoscopy, intraoperative conversion to open surgery can be justified.

Abstract: Gallbladder perforation is a lethal complication of cholecystitis, a relatively common disease, and has a mortality of 15 to 20 per cent. At UCLA Hospital seventeen patients with perforation of the gallbladder were evaluated and compared with patients who had previously been reported in the English literature. The purpose of this report was to: (1) establish a set of criteria to identify the patient who is at high risk for gallbladder perforation; (2) detail an appropriate course of diagnostic and therapeutic management; and (3) propose a unified concept of the pathogenesis of gallbladder perforation. The majority of patients were elderly men (mean age, 61 years) and women (mean age, 67 years) with significant atherosclerotic cardiovascular disease or underlying malignancy. Another important subset of patients consisted of young men who were receiving long-term steroid or immunosuppressive therapy for collagen vascular disease. Almost all of the patients with gallbladder perforation were subjected to an inordinate delay in diagnosis and surgical intervention (6.8 days), and this was responsible for a significant complication rate of 58 per cent as well as an extended postoperative hospitalization time (16 days). The mortality for the entire series was 17 per cent. The successful management of gallbladder perforation is based on early recognition of the patients who are at high risk for this condition. Preoperative diagnostic and therapeutic measures can usually be performed within 12 hours and should include ultrasonography or intravenous cholangiography, fluid resuscitation, nasogastric decompression, and broad spectrum antibiotic administration. A successful outcome in these patients, however, can be achieved only with operative intervention.