91Saudi Journal of Medicine & Medical Sciences | Vol. 3 | Issue 1 | January 2015 | 91-91

Gallbladder Perforation

A 42 years old female, obese with no other signifi cant 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 Figures 1 and 2.

QUESTIONS

What are the fi ndings ?

What is the diagnosis ?

Access this article onlineQuick Response Code:

Website:www.sjmms.net

DOI:10.4103/1658-631X.149698

IMAGE QUIZ

Figure 1: Computed tomography image 1 for quiz question.

Figure 2: Computed tomography image 2 for quiz question.

ANSWER

See answer in page 92.

[Downloaded free from http://www.sjmms.net on Monday, February 08, 2016, IP: 41.36.242.253]

Saudi Journal of Medicine & Medical Sciences | Vol. 3 | Issue 1 | January 2015 | 92-9292

ANSWERS OF QUIZ

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]

Mohd I. Dar, Imran N. Salroo1, Sabina Y. Bhat, Sartaj A. Bhat2

Departments of Medicine, 1Radiodiagnosis and 2Paediatrics, Government Medical College, SMHS Hospital, Srinagar,

Jammu and Kashmir, India

Correspondence: Dr. Mohd Iqbal Dar, Department of Medicine, Government Medical College, SMHS Hospital,

Srinagar - 190 010, Jammu and Kashmir, India.E-mail: darmohdiqbal@yahoo.in

REFERENCES1. Niemeier OW. Acute free perforation of the gall-bladder. Ann Surg

1934;99:922-4.

2. Roslyn JJ, Thompson JE Jr, Darvin H, DenBesten L. Risk factors for gallbladder perforation. Am J Gastroenterol 1987;82:636-40.

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.

FINDINGS

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 fi nding in the transverse plane as shown by the arrow.

DIAGNOSIS

Gallbladder perforation with biliary peritonitis.

COMMENTS

Gallbladder perforation (GBP) is a rare and dangerous complication of acute cholecystitis. Niemeier presented his fi rst classifi cation of GBP in 1934. He classifi ed 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 fi stula.[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

Figure 3: Computed tomography image 1 for an answer of quiz. Figure 4: Computed tomography image 2 for an answer of quiz.

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

Source of Support: Nil. Confl ict of Interest: None declared.

[Downloaded free from http://www.sjmms.net on Monday, February 08, 2016, IP: 41.36.242.253]