title: Gallbladder perforation: a single center experience of 32 cases.
abstract: OBJECTIVE
  Gallbladder perforation is a rare but potentially fatal disease. We herein present our clinical experience in diagnosis and management of 32 cases of gallbladder perforation.
  
  
  METHODS
  This retrospective study was conducted with inclusion of all cases of gallbladder perforation that presented to our hospital from January 2012 to November 2014. Cases of traumatic gallbladder perforation and patients younger than 12 years of age were excluded from this study.
  
  
  RESULTS
  This study included 32 patients (13 males and 19 females). The mean age of patients was 55.9 years. Gallbladder perforation was most common in the 5th and 6th decade of life. The mean age of patients with type I, II, and III gallbladder perforation was 57.0 years, 57.6 years, and 49.8 years, respectively. The most common site of perforation was the fundus, followed by the body and Hartmann's pouch (24 : 5 : 2). Most of the type I gallbladder perforations were diagnosed intraoperatively, type II gallbladder perforations were diagnosed by enhanced abdominal computed tomography, and type III gallbladder perforations were diagnosed during laparoscopic cholecystectomy converted to open cholecystectomy for cholelithiasis. Mortality was highest in patients with type I gallbladder perforation. The mean hospital stay was 10.1 days, 6.4 days, and 9.2 days in patients with type I, II, and III gallbladder perforation, respectively. The histopathologic analysis in 28 patients who were operated on showed acute cholecystitis in 19 cases, acute-on-chronic cholecystitis in 4 cases, chronic cholecystitis in 4 cases, and mucinous adenocarcinoma of the gallbladder in a single case.
  
  
  CONCLUSIONS
  Gallbladder perforation represents a special diagnostic and surgical challenge. Appropriate classification and management are essential.
authors.affiliation: Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
authors.forename: Gopalakrishnan
authors.initials: G
authors.lastname: Gunasekaran
authors.affiliation: Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
authors.forename: Debasis
authors.initials: D
authors.lastname: Naik
authors.affiliation: Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
authors.forename: Ashwani
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
authors.forename: Vimal
authors.initials: V
authors.lastname: Bhandari
authors.affiliation: Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
authors.forename: Manigandan
authors.initials: M
authors.lastname: Kuppusamy
authors.affiliation: Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
authors.forename: Gaind
authors.initials: G
authors.lastname: Kumar
authors.affiliation: Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
authors.forename: Niuto S
authors.initials: NS
authors.lastname: Chishi
keywords: Acute cholecystitis; Cholecysto-enteric fistula; Gallbladder perforation; Hole sign; Percutaneous catheter drainage