Abstract
Idiopathic perforation of the gallbladder (IPGB) is a rare event, and the underlying mechanisms are unknown. We investigated the clinicopathological characteristics of this disorder. We reported a case of IPGB, and reviewed 30 other cases reported up to the end of 2005 in a Medline and Japan Centra Revuo Medicina search of the medical literature. We analyzed the clinical findings, laboratory data, and histopathological features. The mean age of the patients was 70.2 ± 12.8 years, and there were 19 men and 12 women. Underlying diseases such as hypertension, cerebral infarction or hemorrhage, renal failure, respiratory failure, and malignancy were reported in 35.5% of the patients. Perforation was found more often in the fundus (53.3%) than in the body (43.3%) or neck (3.3%) of the gallbladder. Thrombus was found in the intramural vessels of the gallbladder wall in 13 patients (50%), whereas 13 (50%) were free of thrombus. Serum amylase was significantly higher in the intramural vessels in the thrombus-negative group than in the thrombus-positive group. The overall operative mortality was 3.3%. Univariate and multivariate analyses indicated that a delay of more than 24 h from the manifestation of symptoms to operation and a perforation size greater than 2 cm required significantly longer hospitalization. Thrombosis in the intramural vessels seems to be related to the events leading to IPGB; however, it is difficult to consider it the only cause. Early operation and the size of the perforation are important determinants of the outcome of treatment for IPGB.
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References
J Roslyn RW Busuttil (1979) ArticleTitlePerforation of the gallbladder: a frequently mismanaged condition Am J Surg 137 307–12 Occurrence Handle434321 Occurrence Handle10.1016/0002-9610(79)90056-4 Occurrence Handle1:STN:280:DyaE1M7mtlejug%3D%3D
CL Ong TH Wong A Rauff (1991) ArticleTitleAcute gall bladder perforation: a dilemma in early diagnosis Gut 32 956–8 Occurrence Handle1885081 Occurrence Handle1:STN:280:DyaK3MzlslGrtg%3D%3D
M Tanaka H Takahashi Y Yazima K Okamura A Kosaka R Mizumoto (1997) ArticleTitleIdiopathic perforation of the gallbladder: report of a case and a review of the literature Surg Today 27 360–3 Occurrence Handle9086556 Occurrence Handle10.1007/BF00941814 Occurrence Handle1:STN:280:DyaK2s3ktFWrtw%3D%3D
S Kobayashi H Ozawa S Suzuki N Karaji T Tanida (1981) ArticleTitleA case of spontaneous perforation of the gallbladder followed by hemorrhagic gastric ulcer (in Japanese) Rinnsyogeka 12 1931–5
JG Thornton (1984) ArticleTitleSpontaneous perforation of the gallbladder without gallstones Br J Surg 71 314 Occurrence Handle6704685 Occurrence Handle10.1002/bjs.1800710422 Occurrence Handle1:STN:280:DyaL2c7lsFeluw%3D%3D
N Ozaki H Kuroda T Ueda Y Tanaka Y Saito (1989) ArticleTitleA case of idiopathic gallbladder perforation (in Japanese) Tann Sui 10 1271–4
T Takahashi T Minabe T Mori T Tanahashi K Nara (1989) ArticleTitleA case report of perforation of the acalculous gallbladder occurring from the thrombosis of cystic artery (in Japanese) Nihon Shokakigeka Gakkaizasshi (Jpn J Gastroenterol Surg) 22 2744–7
Y Saiki Y Kumagaya K Aoki S Wada S Sokuhara (1990) ArticleTitleA case of idiopathic perforation of the gallbladder (in Japanese) Tann Sui 11 477–81
T Yamamoto T Kato K Takeuchi H Nishiwaki Y Ito (1993) ArticleTitleIdiopathic perforation of the gallbladder: a case report and review of reported cases in the Japanese literature (in Japanese with English abstract) Nihon Rinnsyogeka Gakkaizasshi (J Jpn Soc Clin Surg) 54 2365–8
T Shiratori Y Watanabe (1993) ArticleTitleSpontaneous perforation of the gallbladder: case report (in Japanese with English abstract) Nihon Rinnsyogeka Gakkaizasshi (J Jpn Soc Clin Surg) 54 1871–5
K Kakisako A Kuwahara I Tada K Etoh M Kobayashi (1994) ArticleTitleA case of idiopathic perforation of the gallbladder (in Japanese with English abstract) Nihon Rinnsyogeka Gakkaizasshi (J Jpn Soc Clin Surg) 55 452–6
Y Koike K Fukutomi K Kikuchi S Horie H Sano R Iwanaga et al. (1994) ArticleTitleIdiopathic perforation of the gallbladder: a case report (in Japanese with English abstract) Shiritsu Sapporo Byouin Ishi 54 233–5
I Matsumoto M Hirano H Saito N Murakami H Koizumi Y Mochiki et al. (1995) ArticleTitleA case of spontaneous perforation of the gallbladder (in Japanese with English abstract) Nihon Rinnsyogeka Gakkaizasshi (J Jpn Soc Clin Surg) 56 2673–6
S Migou S Kohdono K Ohtsuka K Ushijima M Kikuchi (1995) ArticleTitleA case of spontaneous perforation of the gallbladder (in Japanese with English abstract) Nihon Rinnsyogeka Gakkaizasshi (J Jpn Soc Clin Surg) 56 2677–80
K Nakazawa S Matsuo N Umekita T Maeshiro S Miyamoto F Yamada et al. (1997) ArticleTitleA case of spontaneous perforation of the gallbladder (in Japanese with English abstract) Nihon Rinnsyogeka Gakkaizasshi (J Jpn Soc Clin Surg) 58 2637–40
T Nomura Y Shirai K Hatakeyama (1997) ArticleTitleSpontaneous gallbladder perforation without acute inflammation or gallstones Am J Gastroenterol 92 895 Occurrence Handle9149210 Occurrence Handle1:STN:280:DyaK2s3ptlWmtQ%3D%3D
M Hasegawa N Wada K Kozawa S Naka T Nojiri T Nagao et al. (1998) ArticleTitleSpontaneous perforation of the gallbladder: a case report and review of reported cases in the Japanese literature (in Japanese) Nippon Hukubu Kyukyu Igakukai Zasshi 18 339–43
T Sato T Nakai Y Matsuura H Kono Y Kitagawa M Nishigaki et al. (1998) ArticleTitleA case of idiopathic perforation of the gallbladder (in Japanese with English abstract) Nihon Rinnsyogeka Gakkaizasshi (J Jpn Soc Clin Surg) 59 501–5
T Ikeya M Tsuda T Ueda (1998) ArticleTitleA case of idiopathic perforation of the gallbladder (in Japanese with English abstract) Nihon Rinnsyogeka Gakkaizasshi (J Jpn Soc Clin Surg) 59 2665–8
M Nishina C Fujii N Takada A Kohama (1999) ArticleTitleA case of spontaneous perforation of gallbladder associated with bile peritonitis (in Japanese) Geka 61 447–9
H Fujii A Tokuyama K Oba E Okuda T Yamamoto H Kinoshita (2000) ArticleTitleA case of panperitonitis caused by spontaneous perforation of the gallbladder (in Japanese) Geka 62 842–4
H Kasajima Y Nishizawa T Nodagashira M Hujita S Takaya M Sasaki (2000) ArticleTitleA case of spontaneous perforation of the gallbladder: a case report and review of reported cases in the Japanese literature (in Japanese with English abstract) Nihon Rinnsyogeka Gakkaizasshi (J Jpn Soc Clin Surg) 61 3321–5
M Hata Y Murano K Norimoto K Okuchi (2002) ArticleTitleSpontaneous perforation of the gallbladder diagnosed and treated by emergency laparoscopy: a case report (in Japanese with English abstract) Nihon Rinnsyogeka Gakkaizasshi (J Jpn Soc Clin Surg) 63 1773–6
M Yoshida K Miyanaga M Uchinami T Kimura T Horiuchi K Tanaka (2003) ArticleTitleA case of spontaneous perforation of the gallbladder (in Japanese) Shokakigeka 26 1535–9
M Watanabe K Takamura M Goto A Tsunoda M Kusano (2004) ArticleTitleA case of spontaneous perforation of the gallbladder diagnosed preoperatively using ultrasound (in Japanese with English abstract) Nihon Rinnsyogeka Gakkaizasshi (J Jpn Soc Clin Surg) 65 1646–9
S Yoshikawa K Iwase J Higaki S Mikata M Miyazaki H Ide et al. (2004) ArticleTitleA case of idiopathic perforation of the gallbladder associated with arteriovenous malformation (in Japanese with English abstract) Nihon Shokakigeka Gakkaizasshi (Jpn J Gastroenterol Surg) 37 1407–11
OW Nimeier (1934) ArticleTitleAcute free perforation of the gallbladder Ann Surg 99 922–4 Occurrence Handle10.1097/00000658-193499060-00005
JCU Coelho ACL Campos M Moreira AA Moss GV Artigas (1991) ArticleTitleAcute acalculous cholecystitis Int Surg 76 146–8 Occurrence Handle1938201 Occurrence Handle1:STN:280:DyaK38%2FktVKktA%3D%3D
N Aihara K Yoshinaga Y Shoji K Kojima Z Nihei Y Mishima (1997) ArticleTitlePerforation of acalculous cholecystitis associated with localized atherosclerosis: report of a case Surg Today 27 357–9 Occurrence Handle9086555 Occurrence Handle10.1007/BF00941813 Occurrence Handle1:STN:280:DyaK2s3ktFWrtg%3D%3D
BL Warren (1992) ArticleTitleSmall vessel occlusion in acute acalculous cholecystitis Surgery 111 163–8 Occurrence Handle1736386 Occurrence Handle1:STN:280:DyaK387ktF2isg%3D%3D
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Namikawa, T., Kobayashi, M., Okabayashi, T. et al. Clinicopathological Analysis of Idiopathic Perforation of the Gallbladder. Surg Today 37, 633–637 (2007). https://doi.org/10.1007/s00595-006-3476-2
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DOI: https://doi.org/10.1007/s00595-006-3476-2