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
• 来源期刊: 国际肝胆胰疾病杂志（英文版）
• 年，卷（期）: 2022,（2）
• 所属期刊栏目: Biliary
• 页码范围: 168-174
• 页数: 7页
• 语种: 英文

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 depart-ment between January 2010 and June 2018.Results:We identified 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 gall-bladder stones(84.8％)followed by common bile duct stones(30.5％),xanthogranulomatous cholecystitis(17.9％)and malignancy(11.9％).As per Niemeier classification,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(cholecysto-enteric fistula).About 60％of the perforations were diagnosed preoperatively.Type 1 was more com-mon 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.