Gallbladder perforation A case series and review of the literature

Abstract

INTRODUCTION: Gallbladder perforation (GBP) is an uncommon life-threatening and almost exclusive complication of
cholecystitis. It is often associated with relatively high morbidity and mortality rates due to delay in diagnosis. GBP still
continues to be a challenging issue for the surgeons. Most cases can only be diagnosed during surgery. The aim of this
retrospective, case series was to present our clinical experience with gallbladder perforation and to provide an overview
of promoting factors, clinical manifestations, diagnostic workup and management of GBP on the basis of recent literature review.

PATIENTS AND METHODS: This study involved four patients with gallbladder perforation (three males and one female),
who were treated in our department from May 2019 to November 2019. We made a retrospective analysis of these
patients and a review of the related literature.

RESULTS: According to Niemeier’s classification, all patients had type II gallbladder perforation. Mean age was 70 years
(range 50-85 years). They had also significant comorbidities, of which diabetes mellitus was the most common (three
patients). Ultrasonography was the initial mode of investigation in these four patients. Out of the four cases, three
patients underwent immediate intervention and only one patient was initially managed conservatively with intravenous
antibiotics.

CONCLUSIONS: Early diagnosis of gallbladder perforation and immediate intervention are of crucial importance. Clinical
examination, diagnostic imaging and high index of suspicion of this severe condition would be significant in establishing an early diagnosis of the perforation