Presentation
We report the case of a 2-year-old girl who presented with peritonitis secondary to spontaneous gallbladder perforation. [ncbi.nlm.nih.gov]
Entire Body System
- 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]
Respiratoric
- Tachypnea
She had tachycardia, tachypnea, mild dehydration, and icterus. [archintsurg.org]
Gastrointestinal
- Fecal Urgency
In the entire group, gastrointestinal symptoms were prevalent and included flatulence (40%), loose stools or fecal urgency (35%), belching (23%), and nausea (4%). [ncbi.nlm.nih.gov]
- Chronic Abdominal Pain
He had a history of alcoholic liver cirrhosis but no chronic abdominal pain or gallstones. The patient presented with localized peritoneal irritation, and abdominal puncture showed non-clotting blood. [ncbi.nlm.nih.gov]
Liver, Gall & Pancreas
- Liver Mass
Initially, a liver mass with portal vein thrombosis in the background of liver cirrhosis was detected by ultrasound in our case. The hepatocellular carcinoma was impressed according to the clinical presentation and imaging findings. [scipedia.com]
PubMed Central PubMed Google Scholar Bakalakos EA, Melvin WS, Kirkpatrick R: Liver abscess secondary to intrahepatic perforation of the gallbladder, presenting as a liver mass. Am J Gastroenterol. 1996, 91: 1644-1646. [wjes.biomedcentral.com]
Workup
X-Ray
- Gastric Varices
An esophagogastroduodenoscopy showed evidence of esophageal and gastric varices. [scipedia.com]
Microbiology
- 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]
Other ECG Findings
- Ischemic Changes
Further histologic examinations of the perforation site showed ischemic changes. There were no biliary complications after surgery. Nevertheless, the patient died of multiple organ failure at 120 days old. [ncbi.nlm.nih.gov]
Biopsy
- Liver Biopsy
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
Conservative treatment of occult gallbladder perforation is possible and should be performed in high-risk patients. [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]
Prognosis is usually good; postoperative mortality has been minimal. [njcponline.com]
Perforated viscera in typhoid fever: A better prognosis for children. Journal of Pediatric Surgery 1975; 8: 531-532. [acmicrob.com]
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]
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]
The choice of antibiotic is based on the organisms presumed to be involved (see Etiology ). Early in the course of the disease, good results are achieved with the adjuvant administration of a second-generation cephalosporin. [emedicine.medscape.com]
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]
"Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines". Journal of Hepato-Biliary-Pancreatic Surgery. 14 (1): 15–26. doi : 10.1007/s00534-006-1152-y. ISSN 0944-1166. PMC 2784509. [en.wikipedia.org]
Pathophysiology
These patterns may provide pathophysiologic information for surgeon. [ncbi.nlm.nih.gov]
Sleisenger & Fordtran's Gastrointestinal and liver disease pathophysiology, diagnosis, management (9 ed.). [S.l.]: MD Consult. p. 1065. ISBN 9781437727678. [en.wikipedia.org]
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]
The pathophysiology of GBP may be caused by an inflammatory reaction and weakness of its wall in the course of the disease due to multiplication of S. Typhi in high numbers in the bile [ 3 ]. The intense inflammation caused by the highly virulent S. [acmicrob.com]
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
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]