Saudi Journal of Gastroenterology
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CASE REPORT Table of Contents   
Year : 2004  |  Volume : 10  |  Issue : 3  |  Page : 155-156
Gallbladder perforation: A case report and review of the literature


Department of Surgery, Dr. Ram Manohar Lohia hospital, New Delhi, India

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Date of Submission03-Jul-2003
Date of Acceptance06-Jan-2004
 

How to cite this article:
Goel A, Ganguly P K. Gallbladder perforation: A case report and review of the literature. Saudi J Gastroenterol 2004;10:155-6

How to cite this URL:
Goel A, Ganguly P K. Gallbladder perforation: A case report and review of the literature. Saudi J Gastroenterol [serial online] 2004 [cited 2019 Dec 15];10:155-6. Available from: http://www.saudijgastro.com/text.asp?2004/10/3/155/33330


Spontaneous gallbladder perforation is a rare condition and may be a sequel to acute cholecystitis [1] . If left untreated it is associated with high mortality [2],[3] . We present a case of gallbladder perforation in a fourteen-year-old child who presented to our emergency surgical department.


   Case Report Top


A 14-year-old male child presented with history of right upper quadrant abdominal pain since three days. He had no history of trauma, atherosclerosis. cardiovascular, metabolic or collagen vascular disease. Haematological investigations were normal. Haemoglobin was 14g/dl, platelets 3, 10, 000/cu.mm, WBC count 16,000/ cu. mm with neutrophilia, SGPT-701U/L (N15-40) SGOT-80 IU/L (normal-40), alkaline phosphastase 1401U/L (normal<300). The Widal test and sickling test were negative. Abdominal examination revealed an area of localized tenderness in the right upper abdomen. Abdominal ultrasonography was grossly normal except for enlarged gallbladder and pericholecystic fluid and minimal collection in subhepatic space. A tentative diagnosis of acute acalculus cholecystitis with gallbladder perforation was made, laparotomy was performed which revealed about 780m1 of bilious collection and enlarged gallbladder with perforation at fundus. Cholecystectomy was performed after ligation of cystic artery and duct and drain was put in subhepatic space. Adhesions were reported in viscera. Gross examination of gallbladder showed a perforation 2.6mm x 1.2mmin and necrosis at fundus with congestion & edema. Microscopic examination of the wall adjacent to perforation site was suggestive of ischaemia. The liver was heavily bile stained. Bile in the submucosa and sub serosa of the gallbladder was associated with marked foreign body reaction including many foam cells suggesting an ongoing inflammatory process for at least one month. Postoperative period was uneventful and patient was discharged symptom free.


   Discussion Top


The incidence of the gallbladder perforation is reported to vary from 3% to 10% [4] . A mortality rate of 11% reflects the seriousness of this condition [5] . The sites of perforation in decreasing frequency described in literature are junction of cystic and common hepatic duct, common hepatic duct and junction of cystic duct and gallbladder and lastly gallbladder itself [6] . The ruptured gallbladder itself is a very rare clinical situation [7] . Roslyn and Busutte suggested that spontaneous gallbladder perforation is caused by hypoperfusion of viscera, secondary to systemic disease and also reported that the fundus of the gallbladder is the most common site of perforation in gallbladder. However, other hypotheses include trauma, congenital abnormality, infection, pancreatic secretions, obstructions, calculi and abnormal bile [5] . Our patient probably developed spontaneous gallbladder perforation due to ischaemia of gallbladder wall with inflammation and acalculous cholecystitis. Different modalities have been used to detect gallbladder perforation including ultrasound, CT Scan, peritoneal lavage. retrograde cholangiography [8],[9] . Hepatobiliary imaging has been another modality, which has recently been advocated. Lublin and Danforth advocated the detection of gallbladder perforation by diamethyl iminodiacetic acid (HIDA) scan [10]

In conclusion, we suggest that such cases should be properly investigated and underlining cause ascertained. Delay in surgical intervention is the major reason for increased morbidity and mortality associated with gallbladder perforation Emergency cholecystectomy should be considered in patients of acute cholecystitis at an early stage to prevent this complication.[11]

 
   References Top

1.Rosyln JB, Usuttil RW. Perforation of gallbladder: A frequently mismanaged condition. Am J Surg 1979; 137: 307-12.  Back to cited text no. 1    
2.Thornton JG. Spontaneous perforation of gallbladder without gallstones Br J Surg 1984; 71: 314.  Back to cited text no. 2    
3.Sharma R, Mondal A, Sen IB, Swaroop K, Ravishanker L, Kashyap R. Spontaneous perforation of gallbladder during infancy diagnosed an hepatobiliary Imaging. Clinical Nuclear Medicine 1997; 22: 759-61.  Back to cited text no. 3    
4.Babb RR. Acute acalculous cholecystitis: A review. J Clin gastroenterol 1992; 15: 238-41.  Back to cited text no. 4  [PUBMED]  
5.Wig JD, Chowdhary A, Talwar BL. Gallbladder perforations. Aust N Z J Surg. 1984; 54: 531.  Back to cited text no. 5    
6.Beck HI, Jensen PO. Nontraumatic intrahepatic rupture of biliary tree. Acta Chir Scand. 1981; 147: 297.  Back to cited text no. 6    
7.Grreewald G, Stine RJ, Larson RE. Perforation of gallbladder following blunt abdominal trauma. Am Emrg Med. 1987; 16: 452.  Back to cited text no. 7    
8.Carabolona JP, Massengo R. Isolated traumatic perforations of gallbladder two case reports. Am Gastroentrol. Hepatol 1986; 32: 397.  Back to cited text no. 8    
9.Martinaz A, Cancers J, Perez C. Postoperative acute cholecystitis. Sonographic diagnosis. Eur J Radiol 1985; 5: 35.  Back to cited text no. 9    
10.Lublin M, Danforth DN. latrogenic gallbladder perforation: conservative management by percutaneous drainage and cholecystostomy. Am Surg 2001; 67: 760-3.  Back to cited text no. 10  [PUBMED]  
11.Croley GG. Gangrenous cholecystitis: five patients with intestinal obstruction Am Surg 1992; 58: 284-92.  Back to cited text no. 11    

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Correspondence Address:
Amit Goel
561/562, Double Storey, Ground Floor, New Rajinder Nagar, New Delhi-110060
India
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Source of Support: None, Conflict of Interest: None


PMID: 19861840

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