Gallbladder perforation: Preoperative diagnosis by combined imaging techniques

Mihas, Anastasios A.; Lewis, Geoff; Athar, Mohammad; Shueke, Menahen

doi:10.1007/bf01888502

Cited by 7 publications

(3 citation statements)

References 7 publications

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“…Therefore, imaging plays an important role in such patients. Imaging findings on US and CT have been well described in the literature 5−8 . Distended GB, thickened GB wall, pericholecystic fluid, cholelethiasis, bulging of the GB wall and wall defect are the findings described on both US and CT.…”

Section: Discussionmentioning

confidence: 89%

MRI of perforated gall bladder

Sood

Jain

Khandelwal

et al. 2002

Australasian Radiology

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Gall bladder perforation is a dreaded complication of acute cholecystitis that, if not diagnosed early in the course, might have a poor prognosis. Both CT and ultrasonography have been used until now extensively for the diagnosis of acute cholecystitis, but diagnosis of perforation is always difficult. Magnetic resonance, by its superior soft tissue resolution and multiplanar capability, is a better modality and should fare better than ultrasonography and CT, as demonstrated in our case. Magnetic resonance imaging demonstrates the wall of the gall bladder and defects to a much better advantage and more convincingly. In addition, MR colangiopancreatography images demonstrate the biliary tree better than other modalities. We suggest that in the case of acute cholecystitis, if perforation is suspected and CT and ultrasonography are not conclusive, MR should be the modality of choice. It can be used as a first line of investigation; however, it might not be cost-effective.

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Section: Discussionmentioning

confidence: 89%

MRI of perforated gall bladder

Sood

Jain

Khandelwal

et al. 2002

Australasian Radiology

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“…There have been some reports on ultrasonographic (US) and computed tomographic (CT) findings of GB perforation [7][8][9][10]. However, to our knowledge, there have been no reports dealing with comparison of diagnostic accuracy between these two modalities.…”

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confidence: 98%

Gallbladder perforation: Comparison of US findings with CT

et al. 1994

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We compared the ultrasound (US) findings of gallbladder (GB) perforation with computed tomography (CT) in 13 patients with GB perforation confirmed at surgery. The common findings of GB perforation were pericholecystic fluid collection and layering of GB wall on US, pericholecystic fluid collection, streaky omentum or mesentery, and GB wall defect on CT. Pericholecystic fluid collection, layering of GB wall, and cholelithiasis were similarly detected on US or CT. GB wall defect and/or bulging of the GB wall suggested a site of perforation was revealed in five patients (38.5%) on US and nine (69.2%) on CT. CT further disclosed the findings of streaky omentum or mesentery (84.6%). CT was superior to US for diagnosis of GB perforation.

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“…The clinical presentations were signs and symptoms similar to acute cholecystitis accompanied by peritoneal signs, with tenderness, rebounding, or muscle guarding over the right upper quadrant or whole abdomen. The imaging study demonstrated a defect of the gallbladder wall or fluid accumulation around a distended gall bladder found on ultrasound9 10 and/or computed tomography (CT) scan 11 12 Figure 1. shows the typical findings on contrast enhanced CT in a patient with gall bladder perforation.…”

Section: Methodsmentioning

confidence: 99%

Percutaneous transhepatic gall bladder drainage: a better initial therapeutic choice for patients with gall bladder perforation in the emergency department

Huang

Tzeng

et al. 2007

Emergency Medicine Journal

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Objectives: To investigate clinical features and outcomes in patients with acute cholecystitis with gall bladder perforation receiving open cholecystectomy or percutaneous transhepatic gall bladder drainage in the emergency department. Methods: From 1996 through 2005, 33 patients with non-traumatic gall bladder perforation, among 585 patients with acute cholecystitis, were enrolled. Patients were divided into two groups: open cholecystectomy in 16 patients and percutaneous transhepatic gall bladder drainage in 17 patients. Medical records, including demographic data, past history of systemic diseases or gallbladder stones, initial clinical presentations, laboratory data, physical status, therapeutic interventions, and outcomes, were analysed. Results: Mean patient age was 72.6 years (range 54-92 years). 28 patients (84.8%) were male. Median time of symptom onset before emergency department diagnosis was 5 days (range 0.5-30 days). Estimated incidence of gall bladder perforation was 5.6% (33/585). 27 patients (81.8%) had gallstones operatively or in image studies. All patients had either right upper quadrant pain/tenderness or epigastric pain/tenderness. Only 9 (27.3%) patients had positive Murphy's sign. Six patients in the percutaneous transhepatic gall bladder drainage group received further open cholecystectomy. Overall mortality was 24.2% (8/33). The direct cause of death was disease related sepsis in all patients. Patients receiving percutaneous transhepatic gall bladder drainage had a higher survival rate than those receiving open cholecystectomy (100% vs 50%, p,0.001). No differences in complications and length of hospital stay of survivors were observed between groups. Conclusions: In this study, we delineated clinical features of patients with gall bladder perforation. Better clinical outcome is observed for percutaneous transhepatic gall bladder drainage, and this is suggested as an initial therapeutic choice, especially in high risk patients who are likely to need surgery.T he choice of therapeutic modalities for acute cholecystitis includes both open cholecystectomy and percutaneous transhepatic gallbladder drainage. If left untreated, acute cholecystitis can progress to gall bladder perforation. During the past decades, open cholecystectomy has been used to treat acute cholecystitis with gallbladder perforation contributing to the mortality rate ranging from 8.6% to 23% in respective studies.1 2 Risk factors, including older age, increased disease severity, and comorbidities with multiple systemic diseases, were considered to account for the high mortality rate.3 4 In recent years, percutaneous transhepatic gallbladder drainage has been successfully adopted as an alternative or a bridge before elective cholecystectomy for acute cholecystitis, 5 and even used in high risk patients for a greatly improved outcome.5-7 A favourable outcome was also demonstrated in patients with a localised gall bladder perforation under percutaneous transhepatic gallbladder drainage treatment.8 To the best of our knowled...

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Gallbladder perforation: Preoperative diagnosis by combined imaging techniques

Cited by 7 publications

References 7 publications

MRI of perforated gall bladder

MRI of perforated gall bladder

Gallbladder perforation: Comparison of US findings with CT

Percutaneous transhepatic gall bladder drainage: a better initial therapeutic choice for patients with gall bladder perforation in the emergency department

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