%0 Journal Article
%T Acute gallbladder perforation with gallstones spillage in a cirrhotic patient
%A Costanza Chiapponi
%A Stephan Wirth
%A Matthias Siebeck
%J World Journal of Emergency Surgery
%D 2010
%I BioMed Central
%R 10.1186/1749-7922-5-11
%X Asymptomatic cholelithiasis is a frequent condition which affects up to 10% of the adult population in wealthy nations. Acute cholecystitis develops in up to 2% of patients affected by asymptomatic cholelithiasis. Gallbladder perforation occurs in 2 to 11% of acute cholecystitis cases. Due to the high mortality that can be caused by a delay in the correct diagnosis and following adequate surgical treatment, gallbladder perforation represents a special diagnostic and surgical challenge [1].According to Niemeier (1934), perforations are classified into three categories: type I includes patients with free perforation into the peritoneal cavity, type II describes patients with localized perforation and type III patients with cholecysto-enteric fistulas. Less frequent forms include cholecystobiliary fistula and more complex fistula formations [2]. Cases of intrahepatic perforation of the gallbladder with liver abscess and cholecystohepatic communication have also been reported [3].A 49-year-old man with liver cirrhosis and a history of esophagial varices presented to a clinic with upper abdominal pain. He described colicky pain radiating to the back. He denied nausea, vomiting, diarrhea or obstipation. There was no history of gallbladder disease, no prior episode of abdominal discomfort, no medication - especially no NSAIDs - and no history of trauma. A distended abdomen with normal bowel sounds, tenderness in the right upper quadrant and signs of beginning peritoneal irritation were present. The laboratory studies showed a slightly elevated white cell count (12 G/L). All other findings were within the normal limits, including lipase and amylase, bilirubin, liver enzymes and coagulation parameters. Sonography revealed no abnormalities but failed to visualize the gallbladder. Gastroscopy confirmed the presence of type I esophageal varices. No signs of gastritis and no ulcers were reported. Computed tomography of the abdomen revealed several calcified stones in a thick-wal
%U http://www.wjes.org/content/5/1/11