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Zhang XD, Wang XX, Xiong J, Liu MZ. Clinical experience in laparoscopic treatment of gallbladder perforation. J Minim Access Surg 2023; 19:80-84. [PMID: 36722533 PMCID: PMC10034809 DOI: 10.4103/jmas.jmas_227_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 01/20/2023] Open
Abstract
Aim We herein present our clinical experience in laparoscopic surgery for gallbladder perforation (GBP). Materials and Methods Retrospective analysis was performed on the clinical data of 44 patients who diagnosed with GBP from January 2015 to November 2020. Results The mean age of the 44 patients was 64.0 years and the female-to-male ratio was 20:24. The most common type of GBP was Type II, followed by Type I and Type III (31:9:4). 72.7% of the patients were diagnosed with GBP at the time of surgery. Laparoscopic surgery was performed for 38 (86.4%) patients, with a conversion rate of 13.2%. The mean length of hospital stays was 7.8 days. The mortality and morbidity rates were 2.3% and 11.4%, respectively. Conclusions Pre-operative diagnosis of GBP is difficult. Laparoscopic surgery is safe, feasible and effective for patients with GBP.
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Affiliation(s)
- Xing-Diao Zhang
- Department of General Surgery, Dazhou Central Hospital, Dazhou, Sichuan Province, China
| | - Xiang-Xiang Wang
- Department of General Surgery, Dazhou Central Hospital, Dazhou, Sichuan Province, China
| | - Jie Xiong
- Department of General Surgery, Dazhou Central Hospital, Dazhou, Sichuan Province, China
| | - Ming-Zhong Liu
- Department of General Surgery, Dazhou Central Hospital, Dazhou, Sichuan Province, China
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2
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Nassar A, Elshahat I, Forsyth K, Shaikh S, Ghazanfar M. Outcome of early cholecystectomy compared to percutaneous drainage of gallbladder and delayed cholecystectomy for patients with acute cholecystitis: systematic review and meta-analysis. HPB (Oxford) 2022; 24:1622-1633. [PMID: 35597717 DOI: 10.1016/j.hpb.2022.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/03/2022] [Accepted: 04/26/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Compare outcomes of early laparoscopic cholecystectomy (ELC) and percutaneous trans-hepatic drainage of gallbladder (PTGBD) as an initial intervention for AC and to compare operative outcomes of ELC and delayed laparoscopic cholecystectomy (DLC). METHODS English-language studies published until December 2020 were searched. Randomised controlled trials (RCTs) and observational studies compared EC and PTGBD with delayed cholecystectomy for patients presented with acute cholecystitis were considered. Main outcomes were mortality, conversion to open, complications and length of hospital stay. RESULTS Out of 1347 records, 14 studies were included. 205,361 (94.7%) patients had EC and 11,565 (5.3%) patients had PTGBD as an initial intervention for AC. Mortality was higher in PTGBD; HR, 95% CI: [3.68 (2.13, 6.38)]. In contrast, complication rate was significantly higher in EC group (47%) vs PTGBD group (8.7%) in patients admitted to ICU; P-value = 0.011. Patients who had ELC were at higher risk of post-operative complications compared to DLC; RR [95% CI]: 2.88 [1.78, 4.65]. Risk of bile duct injury was six folds more in ELC; RR [95% CI]: 6.07 [1.67, 21.99]. CONCLUSION ELC may be a preferred treatment option over PTGBD in AC. However, patient and disease specific factors should be considered to avoid unfavourable outcomes with ELC.
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Affiliation(s)
- Ahmed Nassar
- The Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK; Department of General Surgery, Aberdeen Royal Infirmary, NHS Grampian, UK.
| | | | - Katharine Forsyth
- Department of General Surgery, Aberdeen Royal Infirmary, NHS Grampian, UK
| | - Shafaque Shaikh
- The Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK; Department of General Surgery, Aberdeen Royal Infirmary, NHS Grampian, UK
| | - Mudassar Ghazanfar
- The Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK; Department of General Surgery, Aberdeen Royal Infirmary, NHS Grampian, UK
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3
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Gupta V, Chandra A, Gupta V, Patel R, Dangi A, Pai A. Gallbladder perforation: A single-center experience in north India and a step-up approach for management. Hepatobiliary Pancreat Dis Int 2022; 21:168-174. [PMID: 34548226 DOI: 10.1016/j.hbpd.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 08/24/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Spontaneous gallbladder perforation (GBP) is an uncommon diagnosis. This study presented the experience of managing spontaneous GBP over nine years at a large, tertiary care university hospital in north India and investigated the outcomes and treatment strategies. METHODS A retrospective review of prospectively maintained digital database of consecutive patients was performed. All patients received medical and/or surgical treatment for spontaneous GBP in our department between January 2010 and June 2018. RESULTS We identified 151 patients (81 females and 70 males) with mean age of 53 years. Most common presenting features were pain (96.7%), fever (54.3%) and jaundice (31.1%). Most common cause was gallbladder stones (84.8%) followed by common bile duct stones (30.5%), xanthogranulomatous cholecystitis (17.9%) and malignancy (11.9%). As per Niemeier classification, 8.6% had type 1 GBP (free perforation in peritoneal cavity), 76.2% had type 2 GBP (localized perforation) and 13.2% had type 3 GBP (cholecysto-enteric fistula). About 60% of the perforations were diagnosed preoperatively. Type 1 was more common in patients with diabetes and also had the worst prognosis. Surgery was performed in 109 patients (72.2%). Seven patients (4.6%) had a postoperative morbidity of Clavien-Dindo III or higher. There were three mortalities in patients who underwent surgery. CONCLUSIONS High index of suspicion is required for preoperative diagnosis of GBP, especially in types 2 and 3. Laparoscopic cholecystectomy can be difficult in these patients and patients may require open or partial cholecystectomy. Early diagnosis and step-up approach for the treatment of GBP is critical.
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Affiliation(s)
- Vivek Gupta
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh 226003, India
| | - Abhijit Chandra
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh 226003, India.
| | - Vishal Gupta
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh 226003, India
| | - Ravi Patel
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh 226003, India
| | - Amit Dangi
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh 226003, India
| | - Ajay Pai
- Department of Surgical Gastroenterology, King George's Medical University, Lucknow, Uttar Pradesh 226003, India
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Aziz MU, Robbin ML. Improved Detection of Gallbladder Perforation Using Ultrasound Small Vessel Slow Flow "Perfusion" Imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:511-518. [PMID: 33885191 DOI: 10.1002/jum.15729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 06/12/2023]
Abstract
Gallbladder (GB) perforation is a potentially fatal cause of acute abdomen. Higher morbidity and mortality are associated with this entity due to delayed diagnosis and treatment. Ultrasound with color/power Doppler and contrast sonography can detect wall discontinuity; however, sometimes it can be subtle or unavailable. Small vessel slow flow "perfusion" imaging allows improved microvascular perfusion detection using different filters, which result in increased spatial resolution and vessel visualization. Noncontrast perfusion imaging was of immense clinical value in the diagnosis of GB perforation in the six cases presented here. To the best of our knowledge, this is the first case report describing efficacy of noncontrast "perfusion" imaging in detection of GB perforation.
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Affiliation(s)
- Muhammad U Aziz
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michelle L Robbin
- Departments of Radiology and Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, USA
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Kim TH. Non-Operative Management of Traumatic Gallbladder Bleeding with Cystic Artery Injury: A Case Report. JOURNAL OF TRAUMA AND INJURY 2021. [DOI: 10.20408/jti.2021.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
<p>Gallbladder injuries are rare in cases of blunt abdominal trauma and are usually associated with damage to other internal organs. If the physician does not suspect gallbladder injury and check imaging studies carefully, it may be difficult to distinguish a gallbladder injury from gallbladder stone, hematoma, or bleeding. Therefore, in order not to miss the diagnosis, the clinical findings and correlation should be confirmed. In the present case, a 60-year-old male presented to a local trauma center complaining of pain in the upper right quadrant and chest wall following a motor vehicle collision. Abdominal computed tomography (CT) showed a hepatic laceration and hematoma in the parenchyma in segments 4, 5, and 6 and active bleeding in the lumen of the gallbladder. Traumatic gallbladder injuries generally require surgery, but in this case, non-operative management was possible with cautious follow-up consisting of abdominal CT and angiography with repeated physical examinations and hemodynamic monitoring in the intensive care unit.</p>
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Krecko LK, Hoyos Gomez T, Scarborough JE, Jung HS. Postoperative Outcomes after Index vs Interval Cholecystectomy for Perforated Cholecystitis. J Am Coll Surg 2021; 232:344-349. [PMID: 33482322 DOI: 10.1016/j.jamcollsurg.2020.11.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Gallbladder perforation is a known morbid sequela of acute cholecystitis, yet evidence for its optimal management remains conflicting. This study compares outcomes in patients with perforated cholecystitis who underwent cholecystectomy at the time of index hospital admission with those in patients who underwent interval cholecystectomy. STUDY DESIGN A retrospective analysis was conducted of 654 patients from the American College of Surgeons NSQIP database who underwent cholecystectomy for perforated cholecystitis (2006-2018). Primary outcomes were 30-day postoperative major and minor morbidity, 30-day mortality, and need for prolonged hospitalization. Patient and procedure characteristics and outcomes were compared using Mann-Whitney rank sum test for continuous variables and Pearson chi-square tests for categorical variables. A subset analysis was conducted of patients matched on propensity for undergoing interval cholecystectomy. RESULTS The 30-day postoperative mortality rate of matched cohort patients undergoing index cholecystectomy was 7% vs 0% of patients undergoing interval cholecystectomy (p = 0.01). The 30-day minor morbidity rates were 2% for index and 8% for interval patients (p = 0.06), and the major morbidity rates were 33% for index and 14% for interval patients (p = 0.003). Of the index patients, 27% required prolonged hospitalization compared with 6% of interval patients (p < 0.001). Results showed similar trends in the unmatched analysis. CONCLUSIONS Patients who underwent index cholecystectomy had significantly longer postoperative hospitalizations and higher 30-day postoperative major morbidity and mortality. There were no differences in 30-day minor morbidity. Selected patients with perforated cholecystitis can benefit from operative management on an interval, rather than urgent, basis.
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Affiliation(s)
- Laura K Krecko
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Tatiana Hoyos Gomez
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI
| | - John E Scarborough
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Hee Soo Jung
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI.
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Krishnamurthy G, Ganesan S, Ramas J, Damodaran K, Khanna A, Patta R. Early laparoscopic cholecystectomy in acute gallbladder perforation: Single-centre experience. J Minim Access Surg 2021; 17:153-158. [PMID: 33723178 PMCID: PMC8083746 DOI: 10.4103/jmas.jmas_176_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Acute gallbladder perforation (GBP) is associated with significant mortality and morbidity. Percutaneous drainage followed by interval cholecystectomy has been the preferred management. The outcomes of early surgery, especially by laparoscopy, have not been well studied in GBP. We present our experience in early laparoscopic cholecystectomy in GBP. Methodology: A retrospective analysis of patients admitted with GBP between April 2014 and December 2018 was done. Clinical presentation, preoperative imaging, surgical procedure, operative findings and the outcomes in these patients were analysed. Video of the surgeries was reviewed in case of the absence of data from the case records. Results: Fifteen patients were treated for GBP during the study period. Eleven patients were male, and the mean age was 61 years. Fourteen patients (93.3%) had associated co-morbidities. Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock were present in 3, 3, 6 and 3 patients, respectively. The location of the collection was gallbladder fossa, pericholecystic, subhepatic and diffuse in 3, 5, 4 and 3 patients, respectively. Intraoperatively, 13 patients were detected to have perforation at the fundus of the gallbladder. Cystic duct stump was managed with clip, endoloop, suturing and external drainage in 7, 2, 5 and 1 patient, respectively. Laparoscopic cholecystectomy was completed in 12 (80%) patients. Retroinfundibular technique was used in 12 (80%) patients. There was one conversion. Two patients required endoscopic retrograde cholangiogram + bile duct stenting, and one was reexplored for cystic artery bleed. There were no mortalities. The median duration of post-operative hospital stay and drain removal was 3 (1–19) and 3 (1–6), respectively. Conclusion: Early laparoscopic cholecystectomy in acute GBP is feasible and can be safely performed in centres having sufficient expertise. Retroinfundibular technique of laparoscopic cholecystectomy is useful in tackling frozen Calot's triangle in GBP.
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Affiliation(s)
- Gautham Krishnamurthy
- Department of Surgical Gastroenterology, SRM Institutes for Medical Science, Chennai, Tamil Nadu, India
| | - Senthil Ganesan
- Department of Surgical Gastroenterology, SRM Institutes for Medical Science, Chennai, Tamil Nadu, India
| | - Jayapriya Ramas
- Department of Surgical Gastroenterology, SRM Institutes for Medical Science, Chennai, Tamil Nadu, India
| | - Karthikeyan Damodaran
- Department of Imaging Sciences, SRM Institutes for Medical Science, Chennai, Tamil Nadu, India
| | - Aswin Khanna
- Department of Surgical Gastroenterology, SRM Institutes for Medical Science, Chennai, Tamil Nadu, India
| | - Radhakrishna Patta
- Department of Surgical Gastroenterology, SRM Institutes for Medical Science, Chennai, Tamil Nadu, India
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Intrahepatic Type II Gall Bladder Perforation Secondary to Acute Acalculous Cholecystitis. Case Rep Surg 2020; 2020:5435921. [PMID: 32274239 PMCID: PMC7132348 DOI: 10.1155/2020/5435921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/18/2020] [Indexed: 11/17/2022] Open
Abstract
Gall bladder perforation is a rare but serious complication of acute cholecystitis. Gall bladder perforations commonly occur in patients with comorbidities and in association with gall stones. We report a rare occurrence of intrahepatic type II perforation of the gall bladder in a previously healthy elderly male with acalculous cholecystitis. Lack of early positive findings related to clinical assessment, laboratory workup, and imaging resulted in a challenging diagnosis. High degree of clinical suspicion and close monitoring in such patients is necessary to detect early deterioration and improve outcomes.
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Beburishvili AG, Panin SI, Zyubina EN. [Perforated cholecystitis. Classification and atypical clinical forms]. Khirurgiia (Mosk) 2018:10-13. [PMID: 29376951 DOI: 10.17116/hirurgia2018110-13] [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] [Indexed: 06/07/2023]
Abstract
AIM To obtain new data for diagnosis and treatment of patients with perforated cholecystitis. MATERIAL AND METHODS It was analyzed the variants of original classification of perforated cholecystitis by Fedorov S.P. - Neimeier O.W. (1934). Moreover, we have assessed treatment of 292 patients with gallbladder perforation (own material of Faculty Surgery Clinic). RESULTS According to continuous 20-year follow-up perforated cholecystitis was observed in 2.9% of patients with various forms of gallbladder inflammation (n=292 out of 10 215). The frequency of atypical clinical forms of gallbladder perforation including multiple and combined perforation, perforation with acute intestinal obstruction and intraabdominal bleeding was 10% (n=29 of 292). Overall mortality in atypical clinical forms related to whole cohort with perforated cholecystitis was 2% (n=6 of 292). CONCLUSION Atypical clinical forms of gallbladder perforation require specific treatment strategy due to the need for emergency surgical interventions. At the same time, the possibilities of video-assisted surgery are somewhat limited compared with other forms of gallbladder inflammation and can be used only in a third of patients.
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Affiliation(s)
- A G Beburishvili
- Volgograd State Medical University, Faculty Surgery Department, Surgical Hepatology Center, Volgograd, Russia
| | - S I Panin
- Volgograd State Medical University, Faculty Surgery Department, Surgical Hepatology Center, Volgograd, Russia
| | - E N Zyubina
- Volgograd State Medical University, Faculty Surgery Department, Surgical Hepatology Center, Volgograd, Russia
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Surgical and non-surgical treatment of non-traumatic gallbladder perforation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2016.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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11
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Hu YR, Pan JH, Tong XC, Li KQ, Chen SR, Huang Y. Efficacy and safety of B-mode ultrasound-guided percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy for acute cholecystitis in elderly and high-risk patients. BMC Gastroenterol 2015; 15:81. [PMID: 26156691 PMCID: PMC4496925 DOI: 10.1186/s12876-015-0294-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 05/27/2015] [Indexed: 12/24/2022] Open
Abstract
Background Standards in treatment of acute cholecystitis (AC) in the elderly and high-risk patients has not been established. Our study evaluated the efficacy and safety of B-mode ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGD) in combination with laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) in elderly and high-risk patients. Methods Our study enrolled 35 elderly and high-risk AC patients, hospitalized between January 2010 and April 2014 at the Wenzhou People's Hospital. The patients underwent B-mode ultrasound-guided PTGD and LC (PTGD + LC group). As controls, a separate group of 35 elderly and high-risk AC patients who underwent LC alone (LC group) during the same period at the same hospital were randomly selected from a pool of 186 such cases. The volume of bleeding, surgery time, postoperative length of stay, conversion rate to laparotomy and complication rates (bile leakage, bleeding, incisional hernia, incision infection, pulmonary infarction and respiratory failure) were recorded for each patient in the two groups. Results All patients in the PTGD + LC group successfully underwent PTGD. In the PTGD + LC group, abdominal pain in patients was relieved and leukocyte count, alkaline phosphatase level, total bilirubin and carbohydrate antigen 19-9 (CA19-9) decreased to normal range, and alanine aminotransferase and aspartate aminotransferase levels improved significantly within 72 h after treatment. All patients in the PTGD + LC group underwent LC within 6–10 weeks after PTGD. Our study revealed that PTGD + LC showed a significantly higher efficacy and safety compared to LC alone in AC treatment, as measured by the following parameters: duration of operation, postoperative length of hospital stay, volume of bleeding, conversion rate to laparotomy and complication rate (operation time of LC: 55.6 ± 23.3 min vs. 91.35 ± 25.1 min; hospitalized period after LC: 3.0 ± 1.3 d vs. 7.0 ± 1.7 d; intraoperative bleeding: 28.7 ± 15.2 ml vs. 60.38 ± 16.4 ml; conversion to laparotomy: 3 cases vs. 10 cases; complication: 3 cases vs. 8 cases; all P < 0.05 ). Conclusion Our results suggest that B-mode ultrasound-guided PTGD in combination with LC is superior to LC alone for treatment of AC in elderly and high-risk patients, showing multiple advantages of minimal wounding, accelerated recovery, higher safety and efficacy, and fewer complications.
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Affiliation(s)
- Yi-Ren Hu
- Department of General Surgery, Wenzhou People's Hospital, The Third Clinical College of Wenzhou Medical University, No. 57 Canghou Street, Wenzhou, 325000, P.R. China.
| | - Jiang-Hua Pan
- Department of General Surgery, Wenzhou People's Hospital, The Third Clinical College of Wenzhou Medical University, No. 57 Canghou Street, Wenzhou, 325000, P.R. China.
| | - Xiao-Chun Tong
- Department of General Surgery, Wenzhou People's Hospital, The Third Clinical College of Wenzhou Medical University, No. 57 Canghou Street, Wenzhou, 325000, P.R. China.
| | - Ke-Qin Li
- Department of General Surgery, Wenzhou People's Hospital, The Third Clinical College of Wenzhou Medical University, No. 57 Canghou Street, Wenzhou, 325000, P.R. China.
| | - Sen-Rui Chen
- Department of General Surgery, Wenzhou People's Hospital, The Third Clinical College of Wenzhou Medical University, No. 57 Canghou Street, Wenzhou, 325000, P.R. China.
| | - Yi Huang
- Department of General Surgery, Wenzhou People's Hospital, The Third Clinical College of Wenzhou Medical University, No. 57 Canghou Street, Wenzhou, 325000, P.R. China.
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Alessiani M, Peloso A, Tramelli P, Magnani E. Successful non-operative management of spontaneous type II gallbladder perforation in a patient with Alzheimer's disease. BMJ Case Rep 2014; 2014:bcr2014204337. [PMID: 24859733 PMCID: PMC4042282 DOI: 10.1136/bcr-2014-204337] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2014] [Indexed: 11/04/2022] Open
Abstract
A 77-year-old man with Alzheimer's disease was admitted to a rural hospital in June 2012 and an acute cholecistytis was first diagnosed. Surgery was not considered as a possible option due to the critical condition of the patient and his severe comorbidities. After 2 days of broad-spectrum antibiotics, the patient worsened and developed severe sepsis. A gallbladder perforation with intrahepatic abscess formation was diagnosed on ultrasonography (US) and abdominal CT scan. The patient underwent percutaneous US-guided gallbladder drainage with resolution of the sepsis and rapid clinical improvement. After 1 month, the drainage was removed and the patient was discharged. He survived in good condition for 18 months and he passed away from pneumonitis in December 2013. This case shows that in a case of acute cholecystitis with gallbladder perforation, percutaneous gallbladder drainage can be a lifesaving procedure in elderly patients with severe comorbidities (including Alzheimer's disease) who are not candidates for elective surgery.
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Affiliation(s)
- Mario Alessiani
- Department of Surgery, Varzi Hospital, Varzi, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | | | | | - Enzo Magnani
- Department of Surgery, Varzi Hospital, Varzi, Italy
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13
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Garg PK, Jain BK, Pandey SD, Rathi V, Puri AS. Simultaneous non-traumatic perforation of the right hepatic duct and gallbladder: an atypical occurrence. Malays J Med Sci 2012; 19:77-80. [PMID: 23610553 PMCID: PMC3629668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 02/08/2012] [Indexed: 06/02/2023] Open
Abstract
Simultaneous non-traumatic perforation of the extrahepatic bile duct and the gallbladder is an uncommon occurrence that has been infrequently reported. We describe a patient with a spontaneous perforation of both the extrahepatic bile duct and the gallbladder. A contrast-enhanced computed tomography (CECT) scan of the abdomen and endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a perforation of the gallbladder and a free leak from the right hepatic duct, respectively. Endoscopic biliary drainage following a sphincterotomy and biliary stent placement led to a dramatic improvement in the patient's general condition. He was subsequently scheduled to undergo an elective cholecystectomy. Repeat ERCP performed at 4 weeks after the initial stenting showed a normal cholangiogram and a distally migrated stent, which was there after removed. However, early stent removal led to re-perforation of hepatic duct and gallbladder. A repeat endoscopic biliary drainage did not help, and the patient developed biliary peritonitis. Surgical exploration revealed a perforation at the fundus of the gallbladder, 400 ml of biliopurulent collection and a frozen Calot's triangle. A subtotal cholecystectomy, gall stone removal, and a thorough peritoneal lavage were undertaken. The patient improved postoperatively. The second biliary stent was removed after 4 months. This case report highlights the role of endoscopic biliary drainage in the management of an extrahepatic bile duct perforation and warns against the early removal of a biliary stent.
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Affiliation(s)
- Pankaj Kumar Garg
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi 110095, India
| | - Bhupendra Kumar Jain
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi 110095, India
| | - Satya Deo Pandey
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi 110095, India
| | - Vinita Rathi
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi 110095, India
| | - Amarendra Singh Puri
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi 110095, India
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Can early laparoscopic cholecystectomy be the optimal management of cholecystitis with gallbladder perforation? A single institute experience of 74 cases. Surg Endosc 2012; 26:3301-6. [DOI: 10.1007/s00464-012-2344-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 04/24/2012] [Indexed: 01/30/2023]
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15
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Date RS, Thrumurthy SG, Whiteside S, Umer MA, Pursnani KG, Ward JB, Mughal MM. Gallbladder perforation: case series and systematic review. Int J Surg 2011; 10:63-8. [PMID: 22210542 DOI: 10.1016/j.ijsu.2011.12.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Revised: 12/02/2011] [Accepted: 12/06/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gallbladder perforation is a serious complication of acute cholecystitis. Its management has evolved considerably since its classification by Niemeier in 1934. This review summarises the evidence surrounding the natural progression of this condition and potential problems with Niemeier's classification, and proposes a management algorithm for the more complex type II perforation. METHODS Data from a retrospective case series and a systematic review were combined. The case series included all patients with gallbladder perforations from 2004 to 2008 at a British teaching hospital. The systematic review searched for gallbladder perforation using the MEDLINE, Embase, Web of Science and Cochrane Library (2011 Issue 4) databases, as well as recent conference abstracts. The outcome data were analysed using SPSS version 15. No adjustments were made for multiple testing. RESULTS 198 patients (including 19 patients from the present series) with a mean age of 62.1+/-9.7 years and male gender proportion of 55.4% (range 33.3-76.7%) were included. The most common gallbladder perforations were type II (median 46.2%, range 7.4-83.3%), followed by type I (median 40.6%, range 16.7-70.0%) and type III (median 10.1%, range 0-48.1%). Perforation was associated with cholelithiasis in 86.6% (range 78.9-90.6%) of patients, and the overall median mortality rate was 10.8% (range 0-12.5%). Male gender was weakly associated with mortality (p = 0.089) but age (p = 0.877) and cholelithiasis (p = 0.425) were not. Mortality did not vary significantly with perforation type. CONCLUSIONS Gallbladder perforation should be reported according to the original Neimeier's classification to avoid heterogeneity in data (e.g. varying rates of perforation types). The algorithm proposed in this study aims to guide the management of complex type II gallbladder perforations to minimise subsequent morbidity and mortality.
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Affiliation(s)
- Ravindra S Date
- Department of Upper Gastrointestinal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK.
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Rikki S, Amit M, Samita G, Bir S, Parul J. Management of gall bladder perforation evaluation on ultrasonography: report of six rare cases with review of literature. J Med Life 2011; 4:364-71. [PMID: 22514568 PMCID: PMC3227160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 09/28/2011] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Perforation of the gall bladder with cholecystohepatic communication is a rare cause of liver abscess. We are reporting here six rare cases of gall bladder perforation with variable clinical presentations. MATERIALS AND METHODS Most patients presented with right hypochondrium pain and fever but two patients presented with only pain in the abdomen. Ultrasonography (USG) and Computed Tomography (CT) were used for diagnosis. The patients were also successfully treated. RESULTS There was a gall bladder perforation with cholecystohepatic communication, leading to liver abscess formation in most cases on USG and CT. The final diagnosis was confirmed on surgery. CONCLUSION The perforation of the gall bladder which leads to liver abscess is a rare complication of acute, chronic or empyema gall bladder. USG and CT scans are the most important diagnostic tool in diagnosing this rare complication. In the set up, where advanced options are not available, the only treatment of choice is the conservative one or surgery, according to the status of the patients.
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Affiliation(s)
- Singal Rikki
- Department of Surgery- Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
| | - Mittal Amit
- Department of Surgery- Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
| | - Gupta Samita
- Department of Radiodiagnosis and Imaging- Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana (Distt -Ambala) Pin Code 133201, Haryana, India
| | - Singh Bir
- Department of Radiodiagnosis and Imaging- Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana (Distt -Ambala) Pin Code 133201, Haryana, India
| | - Jain Parul
- Department of medicine - Maharishi Markandeshwer Institute of Medical Sciences And Research, Mullana, (Distt-Ambala), Haryana, India
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