Gall Bladder perforation

Posted Sun, 05/24/2009 - 23:27 by ashwani sharma
Images

Figure 1 (a)

Figure 1 (b)

Figure 1 (c)


Clinical History:

Patient with Right Upper Quadrant Pain.


Findings:

Figure 1 (a,b,c): Gallstones with sludge and gallbladdeer wall defect with  adjacent fluid collection consisitent with gall bladder perforation.


Diagnosis:

Gall Bladder perforation


Discussion:

Gall bladder perforation is a grave complication of acute cholecystitis. Both CT and ultrasonography are used for the diagnosis of acute cholecystitis, but diagnosis of perforation is always challenging. Magnetic resonance, by its superior soft tissue resolution and multiplanar capability, is emerging as a better tool. Magnetic resonance imaging demonstrates the wall of the gall bladder and defects more convincingly. In addition, MR colangiopancreatography images demonstrate the biliary tree better than other modalities.

 

Neimeier 1proposed a classification of gall bladder perforation (GBP).

Type I or acute- free gall bladder perforation and generalized biliary peritonitis.

Type II or subacute- percholecystic abscess and localized peritonitis.

Type III or chronic- cholecystoenteric fistula.

Perforation usually occurs at the fundus followed by corpus, infundibulum and cystic duct.

 

Although free intraperitoneal perforation is rare, it is associated with a mortality of 25%. Necrosis of the GB wall occurs in about 60% of cases of acalculous cholecystitis because gangrene and perforation are frequent occurrences. Mortality ranges from 9-66%2.

 


References / Suggested Reading:

 

1.      Neimeier DW. Acute free perforation of gallbladder. Ann Surg 1934;99:922-944. 2.      Kimura Y, Takada T, Kawarada Y, Nimura Y, Hirata K, Sekimoto M. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14(1):15-26.

Author

Ashwani Sharma,MD, Shweta Bhatt,MD

Instructor and Assistant Professor

University of Rochester, NY

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