2011, Number 1
Are there clinical or biochemical factors that would allow assuming a preoperatory diagnosis of gallbladder perforation?
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ABSTRACTObjective: 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.
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