Gangrenous Perforation of the Gallbladder

Role of sonography in the diagnosis of gallbladder perforation

“…7 The incidence is still higher in patients with diabetes or malignancy and in immunocompromised patients. 1,2,8,9 Early diagnosis may allow early intervention and thus may reduce the mortality rate.…”

Gallbladder perforation: Comparison of US findings with CT

“…CT revealed additional findings of streaky omental or mesenteric fat, not detected on US. Acute cholecystitis may result in GB perforation in 6-12% of the cases [9], Diffenbaugh et al, [3] reported a mortality rate of GB perforation of 24.1%.…”

“…GB perforation may develop as early as 2 days after the onset of symptoms of acute cholecystitis or as late as several weeks afterward [3][4][5]. Because symptoms of GB perforation are similar to those of uncomplicated acute cholecystitis, it is difficult to discriminate clinically between patients with GB perforation and those with uncomplicated acute cholecystitis [6].…”

Evaluating Patients with Right Upper Quadrant Pain

“…177,178 When the cystic duct is obstructed, progressive gallbladder distention and inflammation is followed by vascular compromise, gangrene, necrosis, and ultimately perforation. 178,179 The fundus is the most frequent site of perforation because of the poor blood supply in this area.…”

“…Associated complications include bacteremia, septic shock, bile peritonitis, and abscess formation with mortalities ranging from 6% to 70%. 177,[180][181][182][183] Gallbladder perforation is subclassified into 3 types 180,181 : (1) acute free perforation into the peritoneal cavity, which is associated with the highest mortality; (2) subacute perforation with pericholecystic abscess, which is the most common; and (3) chronic perforation with cholecystoenteric fistula formation and possible progression to gallstone ileus. Abscess formation may be confined to the gallbladder fossa, spread into the peritoneal cavity, or involve the liver.…”