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Vs VR, Sureka B, Yadav T, Varshney VK, Sharma N, Chaudhary R, Rodha MS, Banerjee M, Elhence P, Khera PS. Gallbladder perforation: Diagnostic accuracy of new CT difficulty score in predicting complicated laparoscopic cholecystectomy. Emerg Radiol 2024; 31:455-466. [PMID: 38780718 DOI: 10.1007/s10140-024-02245-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE 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. METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Vijaya Ram Vs
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS) Jodhpur, Rajasthan, 342005, India
| | - Binit Sureka
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS) Jodhpur, Rajasthan, 342005, India.
| | - Taruna Yadav
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS) Jodhpur, Rajasthan, 342005, India
| | - Vaibhav Kumar Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences (AIIMS) Jodhpur, Jodhpur, Rajasthan, 342005, India
| | - Naveen Sharma
- Department of General Surgery, All India Institute of Medical Sciences (AIIMS) Jodhpur, Jodhpur, Rajasthan, 342005, India
| | - Ramkaran Chaudhary
- Department of General Surgery, All India Institute of Medical Sciences (AIIMS) Jodhpur, Jodhpur, Rajasthan, 342005, India
| | - Mahaveer Singh Rodha
- Department of Trauma and Emergency, All India Institute of Medical Sciences (AIIMS) Jodhpur, Jodhpur, Rajasthan, 342005, India
| | - Mithu Banerjee
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS) Jodhpur, Jodhpur, Rajasthan, 342005, India
| | - Poonam Elhence
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences (AIIMS) Jodhpur, Jodhpur, Rajasthan, 342005, India
| | - Pushpinder Singh Khera
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS) Jodhpur, Rajasthan, 342005, India
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Synchronous gallbladder perforation and appendicitis in a pediatric patient. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Jha AK, Rathore AS, Raikuni K, Gupta R. Spontaneous gallbladder perforation occurring at neck in an 8-year old boy. Afr J Paediatr Surg 2019; 16:43-45. [PMID: 32952142 PMCID: PMC7759084 DOI: 10.4103/ajps.ajps_4_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Spontaneous gallbladder perforation (GBP) is a rare condition. Most of these perforations occur at the fundal region of the gallbladder. Perforation occurring at the neck of the gallbladder seems to be the rarest phenomenon. We herein describe a case of spontaneous GBP occurring at the neck of gallbladder in an 8-year-old boy, which was managed satisfactorily by surgical exploration and cholecystectomy.
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Affiliation(s)
- Ashesh Kumar Jha
- Department of Surgery, Dr. Baba Saheb Ambedkar Medical College, New Delhi, India
| | | | - Kamal Raikuni
- Department of Surgery, Dr. Baba Saheb Ambedkar Medical College, New Delhi, India
| | - Renu Gupta
- Department of Pathology, Dr. Baba Saheb Ambedkar Medical College, New Delhi, India
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4
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Hamura R, Haruki K, Tsutsumi J, Takayama S, Shiba H, Yanaga K. Spontaneous biliary peritonitis with common bile duct stones: report of a case. Surg Case Rep 2016; 2:103. [PMID: 27679466 PMCID: PMC5039139 DOI: 10.1186/s40792-016-0234-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/21/2016] [Indexed: 11/12/2022] Open
Abstract
Spontaneous biliary peritonitis is rare in adults. We herein report a case of spontaneous biliary peritonitis. An 84-year-old man was admitted to our hospital for abdominal pain for 5 days. He developed fever, jaundice, and abdominal rigidity. Computed tomography (CT) revealed massive ascites in the omental bursa and around the liver. The ascites obtained by diagnostic paracentesis was dark yellow-green in color, which implied bile leakage. With a diagnosis of bile peritonitis, the patient underwent emergency exploratory laparotomy. There was massive biliary ascites in the abdominal cavity, especially in the omental bursa. Because exploration failed to demonstrate the perforation site in the gallbladder and biliary duct, we performed abdominal lavage alone. Postoperative endoscopic retrograde cholangiopancreatography showed stones in the common bile duct, and there was no evidence of biliary leakage. Endoscopic retrograde biliary drainage was performed using a plastic stent to reduce the pressure of the common bile duct. After the operation, the patient showed satisfactory recovery and started oral intake on postoperative day 8. However, the patient developed heart failure due to renal dysfunction with nephrotic syndrome at 1 month after the operation. With a diagnosis of rapidly progressive glomerulonephritis due to immune complex, the patient received steroid treatment for nephritis, diuretics, and carperitide for heart failure. Although heart failure and renal dysfunction improved by these treatment, the patients developed toxic epidermal necrolysis which was refractory to intensive treatments including steroid pulse and immunoglobulin, and the patient died 76 days after the operation.
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Affiliation(s)
- Ryoga Hamura
- Department of Surgery, Mashiko Hospital, Saitama, Japan. .,Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Koichiro Haruki
- Department of Surgery, Mashiko Hospital, Saitama, Japan.,Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Jun Tsutsumi
- Department of Surgery, Mashiko Hospital, Saitama, Japan.,Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Sumio Takayama
- Department of Surgery, Mashiko Hospital, Saitama, Japan.,Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroaki Shiba
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Katsuhiko Yanaga
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Katagiri T, Irisawa A, Wakabayashi H, Tsunoda T, Tomoda H, Saito R, Kinuta S. Idiopathic perforation of acalculous gallbladder after insertion of a transpapillary pancreatic stent. Endosc Int Open 2016; 4:E838-40. [PMID: 27540570 PMCID: PMC4988833 DOI: 10.1055/s-0042-109598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/17/2016] [Indexed: 12/20/2022] Open
Abstract
Endoscopic retrograde pancreatocholangiography (ERCP) is associated with many types of adverse events (AEs) but idiopathic perforation of the gallbladder (IPGB) is very rare. Pancreatobiliary reflux is one of the factors involved with occurrence of IPGB 1. Here we present a case of acalculous gallbladder perforation as an AE following the insertion of an indwelling endoscopic nasal pancreatic drainage (ENPD) tube (a pancreatic stent) to obtain pancreatic fluid. In this case, acute pancreatobiliary reflux might have been caused by the insertion of the ENPD-tube.
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Affiliation(s)
- Tomoko Katagiri
- Department of Gastroenterology, Takeda general hospital, Aizuwakamatsu, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwamkamatsu, Japan,Corresponding author Atsushi Irisawa, MD, PhD Department of GastroenterologyFukushima Medical University, Aizu Medical Center21-2, Maeda, Tanisawa, Kawahigashi, Aizuwamkamatsu, 969-3492Japan
| | - Hiroto Wakabayashi
- Department of Gastroenterology, Takeda general hospital, Aizuwakamatsu, Japan
| | - Takuya Tsunoda
- Department of Gastroenterology, Takeda general hospital, Aizuwakamatsu, Japan
| | - Hiroyuki Tomoda
- Department of Gastroenterology, Takeda general hospital, Aizuwakamatsu, Japan
| | - Ryo Saito
- Department of Surgery, Takeda general hospital. Aizuwakamatsu, Japan
| | - Shunji Kinuta
- Department of Surgery, Takeda general hospital. Aizuwakamatsu, Japan
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Kumar S, Kumar S, Kumar S, Gautam S. Spontaneous gallbladder perforation in a patient of situs inversus totalis, misdiagnosed as perforation peritonitis due to gas under the right dome of the diaphragm. BMJ Case Rep 2015; 2015:bcr-2014-208003. [PMID: 26123454 DOI: 10.1136/bcr-2014-208003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Acute biliary tract disease is a common condition in adults. Apart from bile duct perforation, spontaneous perforation of the gallbladder itself is very rare in all age groups; to date, all recorded cases are secondary to coexistent disease. We present the case report of a 60-year-old adult having an idiopathic gallbladder perforation. In our case, an unusual presentation was situs inversus totalis and fundal gas shadow was considered as free air under the right dome of the diaphragm by mistake. The patient underwent laparotomy and emergency cholecystectomy was performed in the perforated gallbladder. To date, no case has been described in the literature.
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Affiliation(s)
- Sanjeev Kumar
- Department of General Surgery, King George's Medical University Lucknow, Lucknow, Uttar Pradesh, India
| | - Shailendra Kumar
- Department of General Surgery, King George's Medical University Lucknow, Lucknow, Uttar Pradesh, India
| | - Suresh Kumar
- Department of General Surgery, King George's Medical University Lucknow, Lucknow, Uttar Pradesh, India
| | - Shefali Gautam
- Department of Anaesthesiology, King George's Medical University, Lucknow, Lucknow, Uttar Pradesh, India
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Hosaka A, Nagayoshi M, Sugizaki K, Masaki Y. Gallbladder perforation associated with carcinoma of the duodenal papilla: a case report. World J Surg Oncol 2010; 8:41. [PMID: 20487525 PMCID: PMC2887867 DOI: 10.1186/1477-7819-8-41] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 05/20/2010] [Indexed: 12/20/2022] Open
Abstract
Background Gallbladder perforation is a rare clinical condition, which mostly occurs following acute cholecystitis associated with cholelithiasis. A tumor of the ampulla of Vater causes gradually progressive symptoms, and is rarely associated with perforation of the gallbladder. Case Presentation A 56-year-old man with carcinoma of the ampulla of Vater presented with spontaneous gallbladder perforation and localized bile peritonitis. He complained of right upper abdominal pain, and laparotomy revealed perforation of the gallbladder with no gallstones. Postoperative upper gastrointestinal endoscopy demonstrated a slightly enlarged duodenal papilla, and biopsy revealed adenocarcinoma of the ampulla. Pylorus-preserving pancreaticoduodenectomy was performed subsequently. Conclusion Ampullary carcinoma can be associated with gallbladder perforation and present with acute manifestations. Immediate surgical treatment is required for this condition.
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Affiliation(s)
- Akihiro Hosaka
- Department of Surgery, Ome Municipal General Hospital, 16-5, Higashi Ome 4-chome, Ome-shi, Tokyo, 198-0042, Japan.
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Alvi AR, Ajmal S, Saleem T. Acute free perforation of gall bladder encountered at initial presentation in a 51 years old man: a case report. CASES JOURNAL 2009. [PMID: 19946477 DOI: 10.1186/1757-1626-166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Gallbladder perforation is a rare but life threatening event. We describe a case of gallbladder perforation encountered at initial presentation. CASE PRESENTATION A 51 years old male, without any known medical co-morbidity, presented with a 1-day history of sudden-onset abdominal pain and abdominal distension. On examination, his abdomen was distended with generalized tenderness on palpation. Abdominal x-ray showed no signs of intestinal obstruction or pneumoperitoneum. Computed tomography scan of the abdomen showed appearance suggestive of gallbladder perforation. The patient was taken to the operating room and a diagnostic laparoscopy was performed revealing yellowish green fluid in the peritoneum. Difficulty in visualization of the anatomy led to conversion of the procedure to an open laparotomy. Intra-operative findings included a perforation near the neck of the gall bladder in association with a 2 x 1 cm gall stone. Near-total cholecystectomy was performed and a single large gall stone was retrieved. The peritoneal cavity was washed with normal saline and a drain was placed. The rectus sheath was closed but the wound was kept open for healing by delayed primary closure. The patient's hospital course was uneventful and he was discharged from the hospital on the 3rd post-operative day. He returned to the clinic after one week whereby his drain was removed and his wound closed. CONCLUSION Gallbladder perforation is an unusual initial presentation of gallbladder disease. Early diagnosis of gallbladder perforation and immediate surgical intervention are of prime importance in decreasing morbidity and mortality associated with this condition.
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Affiliation(s)
- Abdul Rehman Alvi
- Department of Surgery, Section of General Surgery, Aga Khan University, (Stadium Road), Karachi, (74800), Pakistan.
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Alvi AR, Ajmal S, Saleem T. Acute free perforation of gall bladder encountered at initial presentation in a 51 years old man: a case report. CASES JOURNAL 2009; 2:166. [PMID: 19946477 PMCID: PMC2783122 DOI: 10.1186/1757-1626-2-166] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Accepted: 10/26/2009] [Indexed: 11/10/2022]
Abstract
Introduction Gallbladder perforation is a rare but life threatening event. We describe a case of gallbladder perforation encountered at initial presentation. Case presentation A 51 years old male, without any known medical co-morbidity, presented with a 1-day history of sudden-onset abdominal pain and abdominal distension. On examination, his abdomen was distended with generalized tenderness on palpation. Abdominal x-ray showed no signs of intestinal obstruction or pneumoperitoneum. Computed tomography scan of the abdomen showed appearance suggestive of gallbladder perforation. The patient was taken to the operating room and a diagnostic laparoscopy was performed revealing yellowish green fluid in the peritoneum. Difficulty in visualization of the anatomy led to conversion of the procedure to an open laparotomy. Intra-operative findings included a perforation near the neck of the gall bladder in association with a 2 × 1 cm gall stone. Near-total cholecystectomy was performed and a single large gall stone was retrieved. The peritoneal cavity was washed with normal saline and a drain was placed. The rectus sheath was closed but the wound was kept open for healing by delayed primary closure. The patient's hospital course was uneventful and he was discharged from the hospital on the 3rd post-operative day. He returned to the clinic after one week whereby his drain was removed and his wound closed. Conclusion Gallbladder perforation is an unusual initial presentation of gallbladder disease. Early diagnosis of gallbladder perforation and immediate surgical intervention are of prime importance in decreasing morbidity and mortality associated with this condition.
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Affiliation(s)
- Abdul Rehman Alvi
- Department of Surgery, Section of General Surgery, Aga Khan University, (Stadium Road), Karachi, (74800), Pakistan.
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Abstract
OBJECTIVE To investigate the frequency and basis of clinically relevant computed tomographic (CT) findings in patients with atrial fibrillation and acute abdominal pain. MATERIALS AND METHODS We retrospectively identified 30 patients with atrial fibrillation referred for enhanced (n = 26) or unenhanced (n = 4) abdominal CT from our emergency department because of acute nontraumatic abdominal pain. All CT images were independently reviewed by a single reader who evaluated the studies for findings that might explain acute pain. Results were correlated with laboratory and surgical findings, clinical course and outcome, and final diagnosis. RESULTS Eleven (37%) of the 30 patients had CT findings for abdominal pain that related to atrial fibrillation, including end-organ ischemia or infarction (n = 8, 27%) and spontaneous hemorrhage presumably related to anticoagulation (n = 3, 10%). Of the remaining patients, 5 (17%) had nonatrial fibrillation-related CT findings for abdominal pain, and 14 (47%) had no cause for abdominal pain found at CT. CONCLUSIONS Patients with atrial fibrillation who present to CT with acute abdominal pain have a high likelihood of being found with abdominal pathology relating to their atrial fibrillation, such as arterial embolus or hemorrhage, and a lower likelihood of having more typical causes for abdominal pain. Increased awareness of the high likelihood of atrial fibrillation-related causes for abdominal pain may improve diagnoses and triage for this special and difficult population.
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Hashimoto A, Matsushita R, Iizuka N, Kimura M, Matsui T, Tanaka S, Ishikawa A, Endo H, Hirohata S. Henoch-Schönlein pupura complicated by perforation of the gallbladder. Rheumatol Int 2008; 29:441-3. [PMID: 18830597 DOI: 10.1007/s00296-008-0727-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2007] [Accepted: 09/05/2008] [Indexed: 01/05/2023]
Abstract
Henoch-Schönlein purpura is a systemic vasculitis of small vessels characterized by purpura, arthralgias, glomerulonephritis and gastrointestinal involvements which can cause intestinal perforation. A 75-year-old man with renal dysfunction and palpable purpura (petechiae) of which dermal specimen showed leukocytoclastic vasculitis was diagnosed as Henoch-Schönlein purpura. Corticosteroid and cyclosporine were effective, but subsequently he developed pneumocystis pneumonia. After he improved by treatment with trimethoprim-sulfamethoxazole, he presented sudden abdominal pain, caused by perforation of the gallbladder. Histological analysis revealed infiltration of inflammatory cells with bleeding in the gallbladder wall at the site of perforation. It is suggested that inflammatory disruption of capillary walls might lead to the perforation of the gallbladder.
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Affiliation(s)
- Atsushi Hashimoto
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
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