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    Perforation of Gallbladder

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    SuryaAtmajaya
    Gallbladder perforation occurs in 3% of acute cholecystitis cases and is usually caused by gallstones. The mortality rate is 12-16% and the fundus is the most common site of perforation. Perforation risk increases with age, delay in surgery over 2 days from symptoms onset, and presence of other medical conditions. Ultrasound can detect perforation by visualizing defects in the gallbladder wall or free fluid, while early surgical intervention is important for management to avoid increased mortality and morbidity.

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    Perforation of Gallbladder

    Uploaded by

    SuryaAtmajaya
    1K views14 pages
    Gallbladder perforation occurs in 3% of acute cholecystitis cases and is usually caused by gallstones. The mortality rate is 12-16% and the fundus is the most common site of perforation. Perforation risk increases with age, delay in surgery over 2 days from symptoms onset, and presence of other medical conditions. Ultrasound can detect perforation by visualizing defects in the gallbladder wall or free fluid, while early surgical intervention is important for management to avoid increased mortality and morbidity.

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    Gallbladder perforation occurs in 3% of acute cholecystitis cases and is usually caused by gallstones. The mortality rate is 12-16% and the fundus is the most common site of perforation. Perforation risk increases with age, delay in surgery over 2 days from symptoms onset, and presence of other medical conditions. Ultrasound can detect perforation by visualizing defects in the gallbladder wall or free fluid, while early surgical intervention is important for management to avoid increased mortality and morbidity.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    1K views14 pages

    Perforation of Gallbladder

    Uploaded by

    SuryaAtmajaya
    Gallbladder perforation occurs in 3% of acute cholecystitis cases and is usually caused by gallstones. The mortality rate is 12-16% and the fundus is the most common site of perforation. Perforation risk increases with age, delay in surgery over 2 days from symptoms onset, and presence of other medical conditions. Ultrasound can detect perforation by visualizing defects in the gallbladder wall or free fluid, while early surgical intervention is important for management to avoid increased mortality and morbidity.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 14

    PERFORATION OF

    GALLBLADDER
    PERFORATION OF
    GALLBLADDER
    3% of cases of acute cholecystitis.
    Usually associated with the presence of stones.
    The mortality rate : 12%- 16%.
    Fundus (the most distal part with regards to blood
    supply) most common site for perforation
    Can occur as early as 2 weeks or several weeks after
    the onset of cholecystitis.
    Elderly patients are especially susceptible to
    gallbladder perforation.
    The incidence of perforation is known to increase
    fourfold with a delay in surgery of more than 2 days
    from the onset of abdominal symptoms.
    The Gall Bladder and Bile Ducts

    Fundus
    NIEMEIER CLASSIFIED
    GALLBLADDER PERFORATION

    Type I Acute/generalized
    peritonitis
    Type Subacute/pericholecystic
    II abscess and localized
    peritonitis
    Type Chronic/cholecystoenteric
    III fistula
    PATHOPHYSIOLOGY
    Occlusion of the cystic duct most
    often by a calculus rise of
    intraluminal pressure impedes
    venous and lymphatic drainage.
    Vascular compromise and therefore
    leads to necrosis and ultimate
    perforation of gall bladder.
    PREDISPOSING FACTORS
    1. Infections
    2. Malignancy
    3. Trauma
    4. Drugs (e.g. corticosteroids)
    5. Systemic diseases (DM and
    atherosclerotic heart disease)
    CLINICAL PRESENTATION
    May range from an acute generalized
    peritonitis (when fundus is involved) to
    benign non-specific abdominal symptoms
    (when fundus is not involved).
    Clinical differentiation between gallbladder
    perforation and uncomplicated cholecystitis
    can often be difficult because the bile leak
    from a ruptured gallbladder might be
    contained in the extra peritoneal gallbladder
    fossa, and hence might not produce symptoms
    of peritonitis immediately.
    ULTRASOUND FINDINGS
    1. Gall bladder thickening,
    2. distension,
    3. pericholecystic fluid,
    4. positive sonographic Murphy sign.
    5. The hole sign, in which the defect in
    the gall bladder is visualized is the only
    reliable sign of gall bladder perforation.
    ULTRASOUND FINDINGS
    As calculi are often missed on CT,
    sonography followed by CT is preferred
    in suspected biliary pathology.
    The crumpled wall of a decompressed
    gallbladder floating within fluid of the
    gallbladder fossa has a distinctive
    appearance and can be seen in some
    cases of Type 1 perforation.
    MANAGEMENT
    The best form of management is early surgery
    as delay in surgery increases both mortality and
    morbidity of patient.
    Early diagnosis of gall bladder perforation and
    immediate surgical intervention are of crucial
    importance.
    Ultrasound scan and CT scan may not help in
    early diagnosis; however awareness of this
    condition and a high index of suspicion of
    perforation of GB should lead to early surgical
    intervention as emphasized by this case.
    MANAGEMENT
    Cholecystectomy, drainage of abscess if present,
    and abdominal lavage are usually sufficient to
    treat gallbladder perforation.
    Cholecystectomy may be difficult in type III
    gallbladder perforations. If a cholesystectomy is
    performed, additional surgical procedures such
    as repair of the fistula may be required.
    Cholecystectomy can be performed after the
    infection is relived by US guided percutaneus
    drainage in type II gallbladder perforations.

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