Background

Spontaneous gallbladder perforation (GBP) is an uncommon diagnosis. This study presented the experience of managing spontaneous GBP over nine years at a large, tertiary care university hospital in north India and investigated the outcomes and treatment strategies.

Methods

A retrospective review of prospectively maintained digital database of consecutive patients was performed. All patients received medical and/or surgical treatment for spontaneous GBP in our department between January 2010 and June 2018.

Results

We identified 151 patients (81 females and 70 males) with mean age of 53 years. Most common presenting features were pain (96.7%), fever (54.3%) and jaundice (31.1%). Most common cause was gallbladder stones (84.8%) followed by common bile duct stones (30.5%), xanthogranulomatous cholecystitis (17.9%) and malignancy (11.9%). As per Niemeier classification, 8.6% had type 1 GBP (free perforation in peritoneal cavity), 76.2% had type 2 GBP (localized perforation) and 13.2% had type 3 GBP (cholecysto-enteric fistula). About 60% of the perforations were diagnosed preoperatively. Type 1 was more common in patients with diabetes and also had the worst prognosis. Surgery was performed in 109 patients (72.2%). Seven patients (4.6%) had a postoperative morbidity of Clavien-Dindo III or higher. There were three mortalities in patients who underwent surgery.

Conclusions

High index of suspicion is required for preoperative diagnosis of GBP, especially in types 2 and 3. Laparoscopic cholecystectomy can be difficult in these patients and patients may require open or partial cholecystectomy. Early diagnosis and step-up approach for the treatment of GBP is critical.

中文翻译：

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胆囊穿孔：印度北部的单中心经验和升级管理方法

背景

自发性胆囊穿孔 (GBP) 是一种罕见的诊断。本研究介绍了在印度北部一家大型三级医疗大学医院管理自发性 GBP 超过九年的经验，并调查了结果和治疗策略。

方法

对连续患者的前瞻性维护数字数据库进行了回顾性审查。2010 年 1 月至 2018 年 6 月期间，所有患者均在我科接受了自发性 GBP 的药物和/或手术治疗。

结果

我们确定了 151 名平均年龄为 53 岁的患者（81 名女性和 70 名男性）。最常见的表现特征是疼痛 (96.7%)、发热 (54.3%) 和黄疸 (31.1%)。最常见的原因是胆囊结石 (84.8%)，其次是胆总管结石(30.5%)、黄色肉芽肿性胆囊炎 (17.9%) 和恶性肿瘤 (11.9%)。根据 Niemeier 分类，8.6% 的患者患有 1 型 GBP（腹膜腔游离穿孔），76.2% 的患者患有 2 型 GBP（局部穿孔），13.2% 的患者患有 3 型 GBP（胆囊肠瘘）。大约 60% 的穿孔在术前得到诊断。1型在糖尿病患者中更为常见，预后也最差。109 名患者 (72.2%) 接受了手术。7 名患者 (4.6%) 的术后并发症为 Clavien-Dindo III 或更高。接受手术的患者中有 3 人死亡。

结论

GBP 的术前诊断需要高度怀疑，尤其是 2 型和 3 型。这些患者的腹腔镜胆囊切除术可能很困难，患者可能需要开腹或部分胆囊切除术。GBP 的早期诊断和升压治疗至关重要。