A case of acute calculous cholecystitis with contained gall bladder perforation with pericholecystic collections extending to liver parenchyma

  • Dr. Abdul Wajid Kanth Resident Surgery, AFMC Pune
  • Dr. Ravi Prakash Assistant professor, Department of Surgery, CH (SC)
  • Dr. Ravi Saroha Assistant Professor Surgery & Plastic and Reconstructive Surgeon, Department of Surgery, CH (SC)
  • Dr. Sarali Santhosh Raja Resident Surgery, AFMC Pune
Keywords: Gall bladder stone, Acute Calculous Cholecystitis, Liver Parenchyma

Abstract

Gall bladder perforation is a serious complication of acute cholecystitis and represents an advanced stage of the disease. Its clinical presentation is varied and can range from non-specific symptoms to acute generalized peritonitis. In many cases, GB perforation in diagnosis during exploratory laparotomy for peritonitis and with no definite source identified. The presentation of gall bladder perforation can be indistinguishable from uncomplicated acute cholecystitis. A 60 yrs. old male with no known comorbidities presented to a tertiary care hospital with diffuse pain abdomen associated with vomiting and constipation of 04 days’ duration. Clinical evaluation revealed icterus and tenderness in right hypochondrium and generalized peritonitis. Lab investigations revealed conjugated type hyperbilirubinemia and elevated serum Lipase levels and normal Amylase levels. Initial USG revealed Acute acalculous cholecystitis with normal IHBR and normal CBD. Later NCCT abdomen and MRCP were done which revealed calculous cholecystitis with sealed off GB perforation IHBR, CBD, and normal pancreas. The patient was managed non-operatively and responded well. The inflammatory reaction of the peritoneum in bile peritonitis increases the absorption of the spilled conjugated bile from the peritoneal cavity. The conjugated type hyperbilirubinemia without dilatation of the bile duct on imaging examination was the sign of bile leakage into the peritoneal cavity.

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gall bladder with the stone inside
CITATION
DOI: 10.26838/MEDRECH.2020.8.3.509
Published: 2021-05-09
How to Cite
1.
Kanth AW, Prakash R, Saroha R, Raja SS. A case of acute calculous cholecystitis with contained gall bladder perforation with pericholecystic collections extending to liver parenchyma . Med. res. chronicles [Internet]. 2021May9 [cited 2021Jun.19];8(3):163-8. Available from: https://medrech.com/index.php/medrech/article/view/497
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Case Report