ACASE OF SPONTANEOUS PERFORATION OF THE GALLBLADDER

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  • 特発性胆嚢穿孔の1例

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Abstract

An 82-year-old female was admitted to our hospital because of intestinal obstruction. Soon after, she recovered and was getting good clinical course. Suddenly, she gave a generalized abdominal pain and her abdomen was rigid. So a provisional diagnosis of generalized peritonitis was made. Laparotomy revealed generalized bile peritonitis due to a fundal perforation of the gallbladder. Carefull inspection of the stomach, small bowel, and large bowel did not disclose evidence of perforation. We could not find adhesion or any traction between the gallbladder and the other organs, but found a pin-holl rupture of 0.3 centimeter in diameter. Thus, cholecystecotmy was subsequently performed. The gallbladder appered otherwise healthy and no stone was found. Intraoperative cholangiogram revealed no stone nor any obstraction, and the bile was clear.<br> Histopathologically, we could not find no inflammatory change around the site of perforation nor thrombi in the capillary arteries of the gallbladder. Culture of bile yielded no growth of bacteria. Therefore, we finally diagnosed as ideopathic perforation of the gallbladder, which is very rare and only 14 cases were reported in Japan to our knowledge. We can not prove correlation between perforation of the gallbladder and intestinal obstruction. But we considered that dehydration due to intestinal obstruction might cause ischemia of the capillary arteries of gallbladder and result in rupture.

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