Management of Gallbladder Perforation: A Single Center Clinical Experience

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.