Spontaneous asymptomatic gallbladder perforation

Spontaneous gallbladder perforation and colon fistula in hypertriglyceridemia-related severe acute pancreatitis: A case report

BACKGROUND

Gallbladder perforation and gastrointestinal fistula are rare but serious complications of severe acute pancreatitis (SAP). However, neither spontaneous gallbladder perforation nor cholecysto-colonic fistula has been reported in acalculous acute pancreatitis patients.

CASE SUMMARY

A 31-year-old male presenting with epigastric pain was diagnosed with hypertriglyceridemia-related SAP. He suffered from multiorgan failure and was able to leave the intensive care unit on day 20. Three percutaneous drainage tubes were placed for profound exudation in the peripancreatic region and left paracolic sulcus. He developed spontaneous gallbladder perforation with symptoms of fever and right upper quadrant pain 1 mo after SAP onset and was stabilized by percutaneous drainage. Peripancreatic infection appeared 1 mo later and was treated with antibiotics but without satisfactory results. Then multiple colon fistulas, including a cholecysto-colonic fistula and a descending colon fistula, emerged 3 mo after the onset of SAP. Nephroscopy-assisted peripancreatic debridement and ileostomy were carried out immediately. The fistulas achieved spontaneous closure 7 mo later, and the patient recovered after cholecystectomy and ileostomy reduction. We presume that the causes of gallbladder perforation are poor bile drainage due to external pressure, pancreatic enzyme erosion, and ischemia. The possible causes of colon fistulas are pancreatic enzymes or infected necrosis erosion, ischemia, and iatrogenic injury. According to our experience, localized gallbladder perforation can be stabilized by percutaneous drainage. Pancreatic debridement and proximal colostomy followed by cholecystectomy are feasible and valid treatment options for cholecysto-colonic fistulas.

CONCLUSION

Gallbladder perforation and cholecysto-colonic fistula should be considered in acalculous SAP patients.

Sonographic Findings of Gallbladder Perforation With Hepatic Abscesses

Gallbladder perforation is a complication of gallbladder disease. There are high morbidity and mortality rates, and it is believed that this is due to the delay in diagnosis and when the condition is managed conservatively. Sonography combined with computed tomography can be used to identify gallbladder perforation and the presence of hepatic abscesses. Sonographic findings for gallbladder perforation may include the presence of a stone outside of the gallbladder, an obvious defect in the gallbladder wall, and other signs such as distended gallbladder, thickened gallbladder wall, striated appearance of the gallbladder wall, gallstones, debris/sludge, and adjacent abscesses. It is important for a sonographer to recognize these signs so that prompt treatment can be initiated. This case presents the sonographic and computed tomography findings of a type II perforated gallbladder as a result of a large stone that eroded into the liver with the subsequent development of two hepatic abscesses.

Gallbladder perforation: a rare complication of postoperative chemotherapy of gastric cancer

A middle-aged man presented 1 day after being discharged from hospital with completing the first course of postoperative chemotherapy. He suffered a sudden persistent high fever and chills. It was noted that he had a history of a total gastrectomy (with D2 lymphadenectomy) 1 month ago. His admission bloods revealed total bilirubin was 142.2umol/L , indirect bilirubin of 107.6umol/L and white cell count of 20.05×10⁹/L. A color doppler ultrasound scan confirmed fluid and gas around liver and hilus lienis while the gallbladder cannot be detected. During Computed Tomography (CT) guided puncture positioning technology and setting a three-channel tube, about 400 ml of foul smell hazel turbid liquid was drained out. He was diagnosed as gallbladder perforation and he was underwent conservative treatment consist of drainage, banning diet, total parenteral nutrition and intravenous antibiotics. Then he recovered well within the subsequent 10 days and was discharged.