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IMAGE QUIZ
Year : 2015  |  Volume : 3  |  Issue : 1  |  Page : 91-92

Gallbladder perforation


1 Department of Medicine, Government Medical College, SMHS Hospital, Srinagar, Jammu and Kashmir, India
2 Department of Radiodiagnosis, Government Medical College, SMHS Hospital, Srinagar, Jammu and Kashmir, India
3 Department of Paediatrics, Government Medical College, SMHS Hospital, Srinagar, Jammu and Kashmir, India

Date of Web Publication20-Jan-2015

Correspondence Address:
Mohd I Dar
Department of Medicine, Government Medical College, SMHS Hospital, Srinagar - 190 010, Jammu and Kashmir
India
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DOI: 10.4103/1658-631X.149698

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How to cite this article:
Dar MI, Salroo IN, Bhat SY, Bhat SA. Gallbladder perforation. Saudi J Med Med Sci 2015;3:91-2

How to cite this URL:
Dar MI, Salroo IN, Bhat SY, Bhat SA. Gallbladder perforation. Saudi J Med Med Sci [serial online] 2015 [cited 2019 Jun 16];3:91-2. Available from: http://www.sjmms.net/text.asp?2015/3/1/91/149698

A 42 years old female, obese with no other significant medical history presented to emergency department with complaints of abdominal pain, initially localised to upper abdomen later radiated to the entire abdomen and the back, associated with vomiting and fever for 2 days. Baseline investigations showed a high leucocyte count and mildly raised amylase.

An initial diagnosis of intestinal perforation versus acute pancreatitis was made. Contrast-enhanced computed tomography of abdomen was done as shown in [Figure 1] and [Figure 2].
Figure 1: Computed tomography image 1 for quiz question.

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Figure 2: Computed tomography image 2 for quiz question.

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  Questions Top


What are the findings ?

What is the diagnosis ?

Answers of Quiz


  Findings Top


[Figure 1] showed perforation in the body of gallbladder with spillage of the contents in the peritoneal cavity in the coronal plane as shown by the arrow. [Figure 2] showed the same finding in the transverse plane as shown by the arrow [Figure 3] [Figure 4].
Figure 3: Computed tomography image 1 for an answer of quiz.

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Figure 4: Computed tomography image 2 for an answer of quiz.

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  Diagnosis Top


Gallbladder perforation with biliary peritonitis.


  Comments Top


Gallbladder perforation (GBP) is a rare and dangerous complication of acute cholecystitis. Niemeier presented his first classification of GBP in 1934. He classified GBP and biliary perforation into type 1 (acute GBP with generalized biliary peritonitis), type 2 (subacute/pericholecystic abscess with localized peritonitis) and type 3 (chronic/cholecytoentric fistula. [1]

The major risk factors for GBP are age, diabetes and atherosclerotic heart diseases. In these patients, compromised blood supply of gallbladder was the major cause. [2] In young people, it usually occurs in immunocompromised individuals who fail to control the infection. GBP continues to be a diagnostic challenge for surgeons and most of the cases are usually diagnosed intraoperatively. [3]

 
  References Top

1.
Niemeier OW. Acute free perforation of the gall-bladder. Ann Surg 1934;99:922-4.  Back to cited text no. 1
    
2.
Roslyn JJ, Thompson JE Jr, Darvin H, DenBesten L. Risk factors for gallbladder perforation. Am J Gastroenterol 1987;82:636-40.  Back to cited text no. 2
    
3.
Sood BP, Kalra N, Gupta S, Sidhu R, Gulati M, Khandelwal N, et al. Role of sonography in the diagnosis of gallbladder perforation. J Clin Ultrasound 2002;30:270-4.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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