2011, Number 1
Are there clinical or biochemical factors that would allow assuming a preoperatory diagnosis of gallbladder perforation?
Language: Español
References: 23
Page: 26-31
PDF size: 274.91 Kb.
ABSTRACT
Objective: To know the prevalence and to identify which clinical and/or biochemical data can lead to detect gallbladder perforation preoperatively in patients with acute cholecystitis.Setting: General Hospital of Mexico City (Ministry of Health).
Design: Study of cases and controls.
Statistical analysis: Odds ratio, Chi square (χ2), and Student’s t test.
Material and methods: We examined the clinical files of patients operated at the Emergency Ward of the General Hospital of Mexico City in the period between December 2007 and September 2009. We reviewed all patients subjected to cholecystectomy, choosing from them those patients with perforation of the gallbladder (cases) and compared them with paired controls (one perforation with two non-perforated), that is, patients of the same characteristics but without gallbladder perforation. Analyzed variables were age, gender, type of perforation, Murphy’s sign, sign of peritoneal irritation, fever, comorbidities, alcohol or drug consumption, smoking, time of evolution, time of operating room admittance, clinical and paraclinical preoperative diagnosis, type of approach, perforation site, complications, and mortality.
Results: Comparison between each studied variable and the presence or not of perforation reveals fever (temperature › 38°C) as the sole factor with statistical significance, odds ratio of 1.15 (IC 95% from 0.51 to 2.6) P = 0.001.
Conclusions: Prevalence of gallbladder perforation in patients with acute cholecystitis is of 9.7%. The only clinical data related to this complication and that could lead to suspect its diagnosis was fever.
References
Galiano-MJ, Saínz-Menéndez B. Colecistitis aguda en Unidades de Cuidados Progresivos. Arch Cir Gen Dig 04 Jun 2007.
Jensen KH, Jorgensen T. Incidence of gallstones in a Danish population. Gastroenterology 1991; 100: 790-794.
Bates T, Harrison M, Lowe D, Lawson C, Padley N. Longitudinal study of gall stone prevalence at necropsy. Gut 1992; 33: 103-107.
Scheurer U. Clinical manifestations of cholelithiasis and its complications. Praxis (Bern 1994) 1995; 84: 590-595.
Friedman GD. Natural history of asymptomatic and symptomatic gallstones. Am J Surg 1993; 165: 399-404.
Kimura Y, Takada T, Kawarada Y, Nimura Y, Hirata K, Sekimoto M, et al. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007; 14: 15-26.
Kaminski DL, Deshpande Y, Thomas L, Qualy J, Blank W. Effect of oral ibuprofen on formation of prostaglandins E and F by human gallbladder muscle and mucosa. Dig Dis Sci 1985; 30: 933-940.
Janowitz P, Kratzer W, Zemmler T, Tudyka J, Wechsler JG. Gallbladder sludge: spontaneous course and incidence of complications in patients without stones. Hepatology 1994; 20: 291-294.
Indar AA, Beckingham IJ. Acute cholecystitis. BMJ 2002; 325: 639-643.
Glenn F, Moore SW. Gangrene and perforation of the wall of the gallbladder. Arch Surg 1942; 44: 677-86.
Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, et al. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007; 14: 78-82.
Merriam LT, Kanaan SA, Dawes LG, Angelos P, Prystowsky JB, Rege RV et al. Gangrenous cholecystitis: analysis of risk factors and experience with laparoscopic cholecystectomy. Surgery 1999; 126: 680-686.
Neimeier OW. Acute Free Perforation of Gall-Bladder. Ann Surg 1934; 99: 922-944.
Andersson R, Tranberg KH, Bengmark S. Bile peritonitis in acute cholecystitis. HPB Surg 1990; 2: 7-12.
Tsai MJ, Chen JD, Tiu CM, Chou YH, Hu SC, Chang CY. Can acute cholecystitis with gallbladder perforation be detected preoperatively by computed tomography in ED? Correlation with clinical data and computed tomography features. Am J Emerg Med 2009; 27: 574-81.
Khan SA, Gulfam, Anwer AW, Arshad Z, Hameed K, Shoaib M. Gallbladder perforation: a rare complication of acute cholecystitis. J Pak Med Assoc 2010; 60: 228-9.
Roslyn JJ, Busuttil RW. Perforation of the gallbladder: a frequently managed condition. Am J Surg 1979; 137:307-12.
Stefanidis D, Sirinek KR, Bingener J. Gallbladder perforation: risk factors and outcome. J Surg Res 2006; 131: 204-208.
Ergul E, Gozetlik EO. Perforation of gallbladder. Bratisl Lek Listy 2008; 109: 210-214.
Derici H, Kara C, Bozdag AD, Nazli O, Tansug T, Akca E. Diagnosis and treatment of gallbladder perforation. World J Gastroenterol 2006; 12: 7832-7836.
Grande-Pérez P, Pereira JJ, Ramos F. Perforation of the gallbladder with communicating pericholecystic abscess: ultrasonographic diagnosis. Rev Esp Enferm Dig 2009; 101: 565-567.
Morris BS, Balpande PR, Morani AC, Chaudhary RK, MaheshwariM, Raut AA. The CT appearances of gallbladder perforation. Br J Radiol 2007; 80: 898-901.
Williams NF, Scobie TK. Perforation of the gallbladder: analysis of 19 cases. Can Med Assoc J 1976; 115: 1223-1225.