Gall Bladder Perforation: Still an Enigma in Tropics

Abstract

To present our clinical experience with gall bladder perforation with exploring etiology, diagnosis and treatment of it. Fifty-six patients were taken in the study, which had presented in Safdarjung hospital between Jan. 2012 and Jan. 2018. The parameters including age, sex, site of perforation, type of perforation, symptoms, etiology, diagnosis, management and mortality were evaluated. Twenty-one patients had type 1, 25 patients had type 2 and ten patients had type 3 gall bladder perforation according to Niemeier’s classification. Perforation was more common in female (M:F, 25:31) and having co morbid condition. Most common site of perforation was fundus (66%). Type 1 gall bladder perforation mostly diagnosed intraoperatively, type 2 diagnosed preoperatively by CECT abdomen and type 3 were diagnosed during laparoscopic cholecystectomy. Most patients of type 1 gall bladder perforation had been operated in emergency after proper resuscitation and exploratory laprotomy was done. Type 2 and type 3 gall bladder perforation were treated conservatively initially and planned for lap cholecystectomy. Histopathological report was acute cholecystitis (n = 32), chronic cholecystitis (n = 23) and one carcinoma gall bladder. Most of the patients had gall bladder calculus. Eight patients had died due to sepsis and multiple organ failure. Mortality was mostly in type 1 gall bladder perforation. Early diagnosis and treatment is very important aspect in gall bladder perforation. Contrast enhanced CT [CECT] scan of abdomen may play an important role in diagnosis. Patient with gall bladder calculus with co morbid condition needs more attention for management. Mortality can be reduced by early diagnosis and management.