Gallbladder perforation: management in a tertiary care centre


  • Prashant Tubachi Department of Surgery, SDM medical college, Dharwad, Karnataka, India
  • K. Sphurti Kamath Department of Surgery, SDM medical college, Dharwad, Karnataka, India
  • Mallikarjun Desai Department of Surgery, SDM medical college, Dharwad, Karnataka, India
  • Harsha Kodliwadmath Department of Surgery, SDM medical college, Dharwad, Karnataka, India



Acute cholecystitis, Gallbladder perforation, Computer tomography in acute abdomen


Background: Retrospective study in the management of perforated gallbladder and clinical outcome in a tertiary care centre.

Methods: Total of 583 patients underwent laparoscopic or open cholecystectomy between 2015 to 2017. Out of these eleven patients had perforated gallbladder (1.9%). Niemeier’ classification used for gallbladder perforation. Both Ultrasonography and Abdominal computerized tomography was used in this study. The parameters like age, gender, method of management, diagnostic procedures, time between date of admission to time of surgery, surgical treatment, duration of hospital stay and post-operative morbidity were evaluated.

Results: Out of the eleven cases, eight patients were male and three were female. Nine patients were above the age of fifty years. According to Niemer classification, seven patients had type I perforation, three patients had type II perforation and one had type one perforation. Out of the eleven cases, eight were clinically diagnosed to be acute cholecystitis and three were clinically diagnosed to have peritonitis. The cases diagnosed to have peritonitis- underwent immediate intervention. The remaining eight cases were initially managed conservatively with intravenous antibiotics, imaging and workup was done, following which intervention was done.

Conclusions: Early diagnosis and emergency surgical treatment of gallbladder perforation with peritonitis is of crucial importance. If the patient is stable then intervention after optimising has better outcome. Abdominal computerized tomography for acute cholecystitis patients may contribute to the preoperative diagnosis of gallbladder perforation.



Schwartz’s principles of surgery 10th edition Gall bladder and the extrahepatic biliary system, Thai H Pam. McGraw Hill Education; 2014;1309-1340.

Roslyn J, Busuttil RW. Perforation of the gallbladder: a frequently mismanaged condition. Am J Surg. 1979;137(3):307-12.

Niemeier OW. Acute Free Perforation of the Gall bladder. Ann Surg.1934;99:922-4.

Isch JH, Finneran JC, Nahrwold DL. Perforation of the gallbladder. Am J Gastroenterol. 1971;55:451-8.

Roslyn JJ. Risk factors for gall bladder perforation. Am J Gastroenterol. 1987;82:636-40.

Bedirli A. Factors effecting the complications in the natural history of acute cholecystitis. Hepatogastroenterol. 2001;48:1275-8.

Date RS. Gall bladder perforation: case series and systematic review. Int J Surg.2012;10:63-8.

Hayrullah, Dericiet. Diagnosis and treatment of gallbladder perforation. World J Gastroenterol. 2006;12(48);7832-6.

Glenn F. Acute cholecystitis. Surg Gynecol Obstet. 1976;143:56:60.

Menakuru SR, Kaman L, Behera A, Singh R, Katariya RN. Current management of gall bladder perforations. ANZ J Surg. 2004;74:843-6.






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