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ISSN 1405-0099 (Print)

2005, Number 1

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Cir Gen 2005; 27 (1)

Hemoperitoneum secondary to perforation of the gallbladder: Report of one patient

González FRF, Durán GLF

Language: Spanish
References: 11
Page: 75-78
PDF size: 64.26 Kb.


ABSTRACT

Objective:To present a patient with spontaneous perforation of the gallbladder with hemoperitoneum.
Design:Report of one case.
Setting:Third level health care private hospital.
Case description:Man of 62 years of age with a history of 20 years of diabetes and two surgeries due to colonic diverticula perforations and cholelithiasis findings 17 years ago. He was admitted through the emergency service with abdominal pain and not being able to evacuate. At admittance, he coursed with fever, dehydration, tachycardia, and pain to abdominal palpation without other signs of peritoneal irritation, and with leukocytosis and hemoconcentration. Simple abdominal X rays revealed ileum and abundant fecal matter in the right colon; abdominal ultrasonogram was not conclusive; the patient was therefore handled on a diagnosis of intestinal sub-occlusion. A couple of hours later, he presented data of peritoneal irritation and was subjected to laparotomy, finding 2,000 ml of free blood in the cavity, with perforation of the gallbladder fundus and an 8x4 cm calculus; lavage of the cavity and cholecystectomy were performed. Postoperative evolution was torpid, presenting pulmonary thromboembolism on the second day, abdominal wall cellulitis on the sixth day, and spontaneous abscess drainage from the vesicular bed on the seventh day, discarding any other cause for the condition through a second laparotomy. He was treated with antibiotics, and discharged, in good conditions, on the 21st day.
Conclusion:Spontaneous perforation of the gallbladder is an uncommon complication of cholelithiasis that is rarely accompanied by hemoperitoneum. Elective cholecystectomy is recommended in diabetic patients with cholelithiasis.


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