Gallbladder perforation with intrahepatic abscess formation

Abstract

Acute cholecystitis may result in gallbladder perforation in 6% to 12% of the cases.' According to Niemeier's classification, there are three types of gallbladder perforation: type 1, acute free perforation into the peritoneal cavity; type 2, subacute perforation with pericholecystic abscess; and type 3, chronic perforation with cholecystoenteric fistula.2 Perforation of the gallbladder with pericholecystic abscess is a rare condition, which may present with a specific ultrasonographic picture showing a complex cystic mass in gallbladder fossa.' Moreover, perforation of gallbladder with cholecystohepatic fistula and liver abscess is even rarer. We report a case of this unusual condition and present the ultrasonographic findings. CASE REPORTA 60-year-old male patient presented with right upper quadrant abdominal pain for one week before admission. He drank 150 g of alcohol per day for 20 years. The pain was associated with fever, chills, tea-colored urine, and vomiting of bile-stained fluid. No referred pain was described. It was severe for the initial three days, then suddenly improved. On admission, his body temperature was 38" C, pulse rate 80/min, respiration rate 20/min, and blood pressure 130/80 mm Hg. Physical examination revealed sclerae, which were not icteric, and mild tenderness without rebound pain over the right upper quadrant of the abdomen. The liver and spleen were not palpable. The white blood cell count was 14,100/mm3 with 1% bands and 74% segmented.

Atraumatic Gb Perforation: Appearance at Usg With Surgical Correlation

“…A sudden decrease in intensity of pain, caused by relief of high intracholecystic pressure might herald the perforation according to Ethan et al and Chen et al [5,13] Gore et al [14] suggest that perforation and abscess formation should be suspected in those patients with acute cholecystitis who suddenly become toxic and clinical condition deteriorate rapidly. Complications that might follow GB perforation are pneumoperitoneum, bile leakage, liver GB fossa or intraperitoneal abscess formation and small bowel obstruction.…”

“…[2,3] Imaging plays a crucial role in differentiating complicated and uncomplicated acute cholecystitis., [4,5] as signs and symptoms of perforation do not differ significantly from those of uncomplicated cholecystitis. [1,6,7] METHODS It is an observational study done in thirteen (13) patients with Ultrasonographic diagnosis of GB perforation during the year 2012-2015. USG findings were analysed and confirmation of these findings was done at surgery.…”

Spontaneous Perforation of the Gall Bladder: A Case Report

“…A sudden decrease in pain intensity caused by the relief of high intracholecystic pressure might herald the perforation according to Chen et al [8]. Perforation and abscess formation should be suspected in those patients with acute cholecystitis who suddenly become toxic and whose clinical condition deteriorates rapidly as suggested by Gore et al [9].…”

Endoscopic transcystic stent placement for an intrahepatic abscess due to gallbladder perforation

“…Perforation of the gallbladder with cholecystohepatic communication is a rare cause of liver abscess [1][2][3] . Percutaneous drainage with systemic antibiotics is the initial treatment for these conditions [2] .…”

“…However, the presence of a biliary communication is associated with significantly longer periods of catheter drainage, because continuous bile flow into the abscess cavity through the communicating tract hindered the natural healing course, resulting in prolonged healing time [4] . Moreover, the treatment modality has not been fully established [1][2][3] . In this case, surgical management was not considered because of the patient's poor general condition.…”