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Gallbladder Perforation


Presentation

  • We present a case of a novel, minimally invasive treatment, using endoscopic retrograde cholangiopancreatography to place a transcystic drain as a bridge to laparoscopic cholecystectomy.[ncbi.nlm.nih.gov]
  • We report the case of a 2-year-old girl who presented with peritonitis secondary to spontaneous gallbladder perforation.[ncbi.nlm.nih.gov]
  • We present the case of a patient with abdominal pain, in which gallbladder perforation was detected by contrast-enhanced ultrasound. A 90-year-old patient presented to the emergency department with a complaint of acute abdominal pain and vomiting.[ncbi.nlm.nih.gov]
  • Data were retrospectively collected from clinical case notes and a literature review is presented.[ncbi.nlm.nih.gov]
  • A 56-year-old man with carcinoma of the ampulla of Vater presented with spontaneous gallbladder perforation and localized bile peritonitis.[ncbi.nlm.nih.gov]
Wound Infection
  • It has been commonly assumed that contamination by bile in the abdominal cavity could be a cause of infection and lead to the formation of a residual abscess or even to surgical wound infection.[ncbi.nlm.nih.gov]
  • No difference was observed in the rate of wound infections between PGB and non-PGB patients (1.6% versus 1.8%). Only one patient (with an inflamed and perforated gallbladder) developed an early postoperative intra-abdominal abscess.[ncbi.nlm.nih.gov]
  • A wound infection requiring antibiotic therapy developed in only one patient who had not suffered a bile leak.[ncbi.nlm.nih.gov]
  • The gallstone left in the peritoneal cavity acts as a site of infection, while bile spillage may lead to biliary peritonitis these might be the cause of wound infections, intraperitoneal abscesses, adhesions with consequent intestinal obstruction.[slideshare.net]
Soft Tissue Mass
  • Visualization of a wall defect was demonstrated in only five cases (45%) and was associated with a focal echogenic soft-tissue mass. CONCLUSION: Missed perforations by ultrasound may partially result from technical inadequacies.[ncbi.nlm.nih.gov]
Withdrawn
  • INTRODUCTION: Accidental rupture of the gallbladder is an event which occurs in up to 20% of laparoscopic cholecystectomies, mainly in those where dissection is difficult, or during extraction when the gallbladder is withdrawn directly through the laparoscope[ncbi.nlm.nih.gov]

Workup

Positive Widal Test
  • Pre-operative diagnoses of typhoid enteric perforation were made based on a positive Widal test. Intra-operative findings however, were that of bile peritonitis and gallbladder perforation. Both had cholecystectomy.[ncbi.nlm.nih.gov]
Liver Biopsy
  • The authors present a case of iatrogenic perforation of the gallbladder during liver biopsy demonstrated by hepatobiliary scintigraphy. CT and surgical correlation are provided.[ncbi.nlm.nih.gov]
  • Gallbladder perforation is an uncommon complication of percutaneous liver biopsy. Diagnosis is usually made clinically and management has traditionally been by cholecystectomy.[ncbi.nlm.nih.gov]

Treatment

  • CONCLUSION: Early diagnosis and emergency surgical treatment of gallbladder perforation are of crucial importance.[ncbi.nlm.nih.gov]
  • Conservative treatment of occult gallbladder perforation is possible and should be performed in high-risk patients.[ncbi.nlm.nih.gov]
  • This case highlights a unique, rare cause of ruptured HH and the need to consider appropriate treatment for some hemangiomas to avoid this potentially fatal complication.[ncbi.nlm.nih.gov]
  • Early LC should be considered the optimal treatment for gallbladder perforation, and PTGBD LC can be preserved for those who carried a high risk of operation.[ncbi.nlm.nih.gov]
  • We present a case of a novel, minimally invasive treatment, using endoscopic retrograde cholangiopancreatography to place a transcystic drain as a bridge to laparoscopic cholecystectomy.[ncbi.nlm.nih.gov]

Prognosis

  • However, the correct and early diagnosis of gallbladder perforation is important for the treatment and prognosis. We report 4 critically ill patients with ascites.[ncbi.nlm.nih.gov]
  • Given that gallbladder perforation represents an advanced stage of acute cholecystitis, typically occurring in otherwise comorbid patients, the prognosis is often worse.[radiopaedia.org]
  • An accurate and early diagnosis of GBP with liver abscess formation is important so as to start the treatment as soon as possible and thereby improve the prognosis.[scipedia.com]

Etiology

  • The etiology of gallbladder perforation varies greatly and is often unknown. Identified causes include infection, congenital, stones or choledochal cysts.[ncbi.nlm.nih.gov]
  • Although rare and unusual, this case shows that this disorder should be considered in elderly patients presenting with peritonitis with an unknown etiology.[ncbi.nlm.nih.gov]
  • The etiology is not yet clear and further research is warranted. Multiple modalities have been used to assist in diagnosis yet most diagnoses are still made at the time of laparotomy.[medcraveonline.com]
  • […] comprehensive investigation did not disclose any inflammatory/infectious condition (local or systemic) or biliary tract obstruction; moreover, the location of GP at infundibulum and absence of histologic signs of ischemia did not suggest a vascular etiology[journals.lww.com]
  • Iatrogenic gallbladder perforation during laparoscopic cholesystectomy: etiology and sequelae. Am Surg, 65 : 944-8. Johnston, S., O _ Malley, K., McEntee, G., et al. 1994. The need to retrieve the dropped stone during laparoscopic cholecystectomy.[slideshare.net]

Epidemiology

  • Infectious Diseases: Epidemiology and Clinical Practice. 3rd ed. New York: Churchill Livingstone ; 1980. p. 47. 3. Kamble AT, Sarda DK, Chaudhary N, Hatwar S. Gall bladder perforation in typhoid fever.[tropicalgastro.com]
  • Radiology 264(3): 70–8 CrossRef Kimura Y, Takada T, Kawarada Y et al (2007) Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines.[springermedizin.de]
Sex distribution
Age distribution

Pathophysiology

  • These patterns may provide pathophysiologic information for surgeon.[ncbi.nlm.nih.gov]
  • Radiology 264(3): 70–8 CrossRef Kimura Y, Takada T, Kawarada Y et al (2007) Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines.[springermedizin.de]
  • Acute acalculous cholecystitis associated with systemic sepsis and visceral arterial hypoperfusion: a case series and review of pathophysiology. Dig Dis Sci 2003; 48:1960. 36. Venkataramani A, Strong RM, Anderson DS, et al.[qq8oji.tokyo-med.ac.jp]

Prevention

  • We would like to stress the importance of parental supervision to prevent irresponsible use of firecrackers, which can cause potentially life-threatening visceral injuries.[ncbi.nlm.nih.gov]
  • Gallbladder (GB) perforation is a life-threatening complication of acute cholecystitis, and early diagnosis prevents delay in patient management. We present two cases of GB perforation diagnosed by color Doppler ultrasonography.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: During LC careful attention must be taken in order to prevent perforation, and the procedure must be performed by experienced surgeons with adequate instrumentations.[ncbi.nlm.nih.gov]
  • Based on these interesting results, surgeons should make every effort to prevent gallbladder perforation by performing meticulous dissection during the operation.[ncbi.nlm.nih.gov]
  • BACKGROUND: The best policy to prevent the potential hazard of bile and stones spilled at laparoscopic cholecystectomy (LC) is to avoid inadvertent gallbladder (GB) perforations.[ncbi.nlm.nih.gov]

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