title: Perfoation of the gallbladder: 'bait' for the unsuspecting laparoscopic surgeon.
abstract: INTRODUCTION Cholecystectomy is one of the most common elective procedures carried out by general surgeons. Most patients present with typical biliary anatomy and simple gallstone disease. Intraoperative and postoperative courses are frequently predictable and uncomplicated. Nevertheless, a small but significant number of patients experience complicated disease with rare presentations and complex biliary anatomy. Unfortunately, consensus on appropriate care for such patients is lacking. CASE HISTORY We describe three patients who presented with complex manifestations of gallbladder perforation: acute perforation of the gallbladder; a spontaneous cholecystocutaneous fistula; a cholecystoduodenal fistula. The initial presentation, preoperative investigations, and selected surgical strategy for each case are described. CONCLUSIONS The case studies described here illustrate the need for a low index of suspicion for gallbladder perforation. Caution should be exercised in preoperative and intraoperative phases in this patient population.
authors.affiliation: Lister Hospital , UK.
authors.forename: Z
authors.initials: Z
authors.lastname: Mughal
authors.affiliation: Lister Hospital , UK.
authors.forename: J
authors.initials: J
authors.lastname: Green
authors.affiliation: Lister Hospital , UK.
authors.forename: P J
authors.initials: PJ
authors.lastname: Whatling
authors.affiliation: Lister Hospital , UK.
authors.forename: R
authors.initials: R
authors.lastname: Patel
authors.affiliation: Lister Hospital , UK.
authors.forename: T C
authors.initials: TC
authors.lastname: Holme
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D001658:Biliary Fistula / Q000601:surgery; D049448:Cholangiopancreatography, Magnetic Resonance; D002763:Cholecystectomy / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D002764:Cholecystitis / Q000601:surgery; D061887:Conversion to Open Surgery; D017577:Cutaneous Fistula / Q000601:surgery; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D042882:Gallstones / Q000601:surgery; D006801:Humans; D033162:Incidental Findings; D007412:Intestinal Fistula / Q000601:surgery; D008297:Male; D008875:Middle Aged; D000072663:Spontaneous Perforation / Q000601:surgery
keywords: Cholecystectomy; Fistula; Gallbladder; Perforation