Gall bladder perforation - is it still a diagnostic dilemma: a retrospective study

Abstract

Background:Gall bladder perforation though an unusual complication following acute cholecystitis is no longer a cause for diagnostic dilemma among patients presenting with signs and symptoms of peritonitis. This would be possible following a detailed history and a systematic clinical examination of the patients presenting with acute abdomen secondary to gall bladder perforation and confirmation by a readily available diagnostic modality like ultrasound abdomen.

Methods: A total of 18 patients who presented with signs and symptoms of peritonitis following gall bladder perforation over a period of two years were studied retrospectively .A detailed history  elicited from these patients  and a meticulous clinical examination carried out followed  by an ultrasound abdomen  facilitated  an early diagnosis and immediate surgical intervention thereby ensuring a better outcome. Factors which led to gall bladder perforation secondary to acute cholecytsitis were also looked into.

Results:17 patients were preoperatively diagnosed to have gall bladder perforation. 83%of the patients had calculus cholecystitis. Diabetics constituted the majority of the cases (15). 15 out of 18 (83%) patients had type 1 perforation whereas the other 3 had type 2 perforation. 11 patients had undergone subtotal cholecystectomy, 4 cholecystectomy and only 3 patients had cholecystectomy. Infective complication rate was high but only 1 patient had died postoperatively.

Conclusions:A relevant history and a systematic clinical examination along with diagnostic imaging (USG and CT abdomen) would be significant in establishing an early diagnosis of gallbladder perforation. Morbidity and Mortality were high among patients presenting with gall bladder perforation secondary to a calculus cholecystitis.