Gallbladder perforation:A single-center experience in north India and a step-up approach for management

作     者：Vivek Gupta Abhijit Chandra Vishal Gupta Ravi Patel Amit Dangi Ajay Pai Vivek Gupta;Abhijit Chandra;Vishal Gupta;Ravi Patel;Amit Dangi;Ajay Pai

作者机构：Department of Surgical GastroenterologyKing George’s Medical UniversityLucknowUttar Pradesh 226003India 

出 版 物：《Hepatobiliary & Pancreatic Diseases International》 (国际肝胆胰疾病杂志（英文版）)

年 卷 期：2022年第21卷第2期

页      面：168-174页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

基　　金：University of Texas Medical Branch  UTMB 

主　　题：Acute calculus cholecystitis Cholecystectomy Cholecysto-enteric fstula Niemeier classifcation 

摘      要：Background: Spontaneous gallbladder perforation(GBP) is an uncommon diagnosis. This study presented the experience of managing spontaneous GBP over nine years at a large, tertiary care university hospital in north India and investigated the outcomes and treatment strategies. Methods: A retrospective review of prospectively maintained digital database of consecutive patients was performed. All patients received medical and/or surgical treatment for spontaneous GBP in our department between January 2010 and June 2018. Results: We identifed 151 patients(81 females and 70 males) with mean age of 53 years. Most common presenting features were pain(96.7%), fever(54.3%) and jaundice(31.1%). Most common cause was gallbladder stones(84.8%) followed by common bile duct stones(30.5%), xanthogranulomatous cholecystitis(17.9%) and malignancy(11.9%). As per Niemeier classifcation, 8.6% had type 1 GBP(free perforation in peritoneal cavity), 76.2% had type 2 GBP(localized perforation) and 13.2% had type 3 GBP(cholecystoenteric fstula). About 60% of the perforations were diagnosed preoperatively. Type 1 was more common in patients with diabetes and also had the worst prognosis. Surgery was performed in 109 patients(72.2%). Seven patients(4.6%) had a postoperative morbidity of Clavien-Dindo Ⅲ or higher. There were three mortalities in patients who underwent surgery. Conclusions: High index of suspicion is required for preoperative diagnosis of GBP, especially in types 2 and 3. Laparoscopic cholecystectomy can be difficult in these patients and patients may require open or partial cholecystectomy. Early diagnosis and step-up approach for the treatment of GBP is critical.