Perforation of gallbladder.

Objective: Gallbladder perforation is a rare but life threatening complication of acute cholecystitis. Aim of this study is to present our clinical experience with gallbladder perforation.

Material And Methods: Thirty-seven of retrospectively reviewed 1042 acute cholecystitis patients were found to have gallbladder (GB) perforation. Perforations due to trauma, iatrogenic causes, and gallbladder carcinoma were excluded.

Results: Abdominal ultrasound (US) showed gall stones in all of the patients with type-I and type-II gallbladder perforations (GBP), extensive intraperitoneal free fluid in 9 patients with type-I GBP, and a small amount of pericholecystic free fluid in 7 patients with type-II GBP. Abdominal US did not show GB wall defect in any of the patients, but showed intraperitoneal free gall stone in one type-I and one type-II GBP patients. CT revealed GB wall thickening in all of the patients, gall stones in 7 patients, extensive intraperitoneal free fluid in 7 patients, a small amount of pericholecystic free fluid in 8 patients, and GB perforation sites in 4 patients. Abdominal CT and US detected subhepatic abscesses in 3 patients.

Conclusion: Early diagnosis of gallbladder perforation and immediate surgical intervention are of crucial importance. Unfortunately, the limited success of US and CT for detecting the GBP let us advocate early and urgent surgery (Tab. 3, Ref. 13). Full Text (Free, PDF) www.bmj.sk.