Management of Gallbladder Perforation: A Single Center Clinical Experience

Öz

Background: Cholelithiasis and cholecystitis are among the most common general surgery diseases. Gallbladder perforation (GBP) is a rare but potentially fatal complication of these conditions. GBP can present with varied clinical manifestations among patients. We present our clinical experience regarding the diagnosis and treatment of patients treated for GBP in our clinic. Materials and Methods: This study included patients admitted to our clinic between January 2018 and January 2022, diagnosed with GBP either preoperatively or intraoperatively, and treated using medical or surgical meth-ods. Demographic and clinical records were retrospectively collected from the patients' electronic records and analyzed. Results: Eighteen patients (10 males and 8 females) were included in the study. The mean age of the patients was 68.1 ±18.1 years. Neimeier classification revealed that 2 patients had Type I, 14 had Type II, and 2 had Type III GBP. Laparoscopic cholecystectomy was performed on 6 patients, open cholecystectomy on 5, and 3 patients required conversion to open cholecystectomy. Percutaneous cholecystostomy was performed in 3 patients. One patient received medical treatment due to a self-limiting abscess, with cholecystectomy recommended electively. Ultrasonography (USG) and computed tomography (CT) were used together for diagnose in 12 patients. Diagnosis was made in 3 patients only by USG, in 1 patient only by CT, and in 2 patients using both CT and MRI. Sixteen of these patients had comorbidities, with diabetes mellitus (DM) and hypertension (HT) being the most common. The mean hospital stay was 14.4 ± 9.5 days, and mortality occurred in only one patient. Conclusions: Although GBP is a rare but potentially fatal complication of cholecystitis, it is associated with high morbidity and mortality. Lacking specific pathognomonic features, GBP often leads to misdiagnosis or delayed diagnosis. Early diagnosis and prompt surgical intervention are essential for successful outcomes in GBP. Lapa-roscopic cholecystectomy may be challenging in these patients, necessitating open or partial cholecystectomy. Percutaneous cholecystostomy presents a viable option for elderly patients and those with comorbidities.

Anahtar Kelimeler

• Acute cholecystitis
• Cholelithiasis
• Gallbladder perforation.

Destekleyen Kurum

Inonu University Faculty of Medicine Health Sciences Non-Interventional Clinical Research Ethics Committee

Etik Beyan

Ethics committee approval for the study was obtained from the Inonu University Faculty of Medicine Health Sciences Non-Interventional Clinical Research Ethics Committee with the decision numbered 2024/5972 on 14-05-2024 in its 9th session.

Safra Kesesi Perforasyonunun Yönetimi: Tek Merkez Klinik Deneyimi

Öz

Amaç: Kolelitiyazis ve kolesistit en sık görülen genel cerrahi hastalıkları arasındadır. Safra kesesi perfo-rasyonu (SKP), bu durumların nadir görülen ancak potansiyel olarak ölümcül bir komplikasyonudur. SKP, farklı klinik belirtilerle kendini gösterebilir. Kliniğimizde SKP nedeniyle tedavi edilen hastaların tanısı ve tedavisiyle ilgili klinik deneyimimizi sunuyoruz. Materyal ve Metod: Bu çalışmaya Ocak 2018 ile Ocak 2022 arasında kliniğimize başvuran, ameliyattan önce veya ameliyat sırasında SKP tanısı konulan ve tıbbi veya cerrahi yöntemlerle tedavi edilen hastalar dahil edildi. Demografik ve klinik veriler, hastaların elektronik kayıtlarından retrospektif olarak toplandı ve analiz edildi. Bulgular: Çalışmaya on sekiz hasta (10 erkek ve 8 kadın) dahil edildi. Ortalama yaş 68,1 yıl (yaş aralığı: 27-92) idi. SKP'nin Neimeier sınıflamasına göre dağılımı; 2 hastada Tip I, 14 hastada Tip II ve 2 hastada-Tip III SKP şeklindeydi. Altı hastaya laparoskopik kolesistektomi, 5 hastaya açık kolesistektomi uygulandı ve 3 hastada laparoskopik kolesistektomiden açık kolesistektomiye dönüldü. 3 hastaya perkütan kolesis-tostomi uygulandı. Bir hastaya kendiliğinden sınırlanan apse nedeniyle tıbbi tedavi uygulandı ve elektif olarak kolesistektomi önerildi. On iki hastaya tanı koymak için ultrasonografi (USG) ve bilgisayarlı tomog-rafi (BT) birlikte kullanıldı. Tanı, 3 hastada yalnızca USG ile, 1 hastada yalnızca BT ile ve 2 hastada ise hem BT hem de MRI ile konuldu. Bu hastaların 16'sında eşlik eden hastalıklar vardı ve en yaygın olanları diabetes mellitus (DM) ve hipertansiyon (HT) idi. Ortalama hastanede kalış süresi 14,4 gündü ve sadece bir hastada mortalite meydana geldi. Sonuç: SKP, yüksek morbidite ve mortaliteye sahip kolesistitin nadir bir komplikasyonu olmasına rağ-men, spesifik patognomonik özelliklerden yoksundur ve bu da sıklıkla yanlış tanıya veya geç tanıya yol açar. SKP'nin erken tanısı ve acil cerrahi tedavisi çok önemlidir. Laparoskopik kolesistektomi bu hasta-larda zorlayıcı olabilir, açık veya kısmi kolesistektomi gerektirebilir. Perkütan kolesistostomi yaşlı hasta-lar ve eşlik eden hastalıkları olanlar için uygulanabilir bir seçenektir.

Anahtar Kelimeler

• Akut kolesistit
• Safra kesesi taşı
• Safra kesesi perforasyonu.

Destekleyen Kurum

İnönü Üniversitesi Tıp Fakültesi Sağlık Bilimleri Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu

Etik Beyan

Çalışma için etik kurul onayı İnönü Üniversitesi Tıp Fakültesi Sağlık Bilimleri Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu’nun 14-05-2024 tarih ve 9. oturumunda alınan 2024/5972 sayılı karar ile alınmıştır.

Kaynakça

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