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Gallbladder perforation associated with carcinoma of the duodenal papilla: a case report

DOI: 10.1186/1477-7819-8-41

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A 56-year-old man with carcinoma of the ampulla of Vater presented with spontaneous gallbladder perforation and localized bile peritonitis. He complained of right upper abdominal pain, and laparotomy revealed perforation of the gallbladder with no gallstones. Postoperative upper gastrointestinal endoscopy demonstrated a slightly enlarged duodenal papilla, and biopsy revealed adenocarcinoma of the ampulla. Pylorus-preserving pancreaticoduodenectomy was performed subsequently.Ampullary carcinoma can be associated with gallbladder perforation and present with acute manifestations. Immediate surgical treatment is required for this condition.Gallbladder perforation (GBP) is a rare but life-threatening condition, which usually requires immediate surgical intervention. Most cases are complicated by acute cholecystitis associated with cholelithiasis [1], although acute acalculous cholecystitis or intramural vessel thrombosis can sometimes lead to GBP [2,3].A tumor of the ampulla of Vater causes gradually progressive symptoms such as jaundice or weight loss, and rarely presents with acute manifestations [4-6]. In this report, we describe a case of ampullary carcinoma presenting with acute development of GBP and bile peritonitis, and discuss the clinical features of the disease.A 56-year-old man was referred to our hospital with right upper abdominal pain, which had worsened over the previous two days. He had been free of symptoms previously. He had a history of moderate smoking and alcohol consumption, and no appreciable medical or family history. On admission, his body temperature was 37.4°C. Blood examination showed a white blood cell count of 8900/mm3, C-reactive protein level of 0.08 mg/dl, total bilirubin level of 0.6 mg/dl, aspartate aminotransferase level of 57 IU/l, and alanine aminotransferase level of 67 IU/l. Computed tomography (CT) and echography demonstrated distention of the gallbladder and thickening of its wall and dilatation of the common bile duct, but no


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