Case Report
Minimally invasive management of intrahepatic type II gallbladder perforation: a case report Dheidan Alshammari1, Riccardo Memeo1,2,3, Stylianos Tzedakis1, Julie Hargat1, Didier Mutter1,2,3, Jacques Marescaux1,2,3, Patrick Pessaux1,2,3 1
Department of Digestive Surgery, University Hospital of Strasbourg, Strasbourg, France; 2IRCAD, Research Institute Against Digestive Cancer,
Strasbourg, France; 3IHU-Strasbourg, Institute for Image-Guided Surgery, Strasbourg, France Correspondence to: Memeo Riccardo. Department of Digestive Surgery, University Hospital of Strasbourg, Strasbourg, 67000, France. Email: [email protected].
Abstract: Intrahepatic gallbladder perforation (GBP) is a rare medical entity, which creates a cholecystohepatic communication. We describe the case of a 70-year-old patient who presented with abdominal pain and a Niemeier type II GBP. This case report illustrates the minimally invasive management of a rare and life-threatening pathology. Keywords: Gallbladder perforation (GBP); laparoscopic cholecystectomy; Niemeier classification; percutaneous drainage Submitted Jul 21, 2015. Accepted for publication Jul 22, 2015. doi: 10.3978/j.issn.2304-3881.2015.08.02 View this article at: http://dx.doi.org/10.3978/j.issn.2304-3881.2015.08.02
Case presentation A 70-year-old woman was addressed to the emergency department with a right upper quadrant abdominal pain. The patient reported an increasing abdominal pain over the last 10 days, associated with nausea and vomiting. She was admitted to hospital 3 months earlier for acute pancreatitis. She had a Balthazar grade E pancreatitis secondary to gallstone disease with two peripancreatic collections. Her previous admission was also complicated by a septic shock, which required a short stay in the intensive care unit and treatment with antibiotics. Her septicemia was caused by a central venous catheter infection. During her hospital stay, a CT-scan demonstrated the presence of gallbladder (GB) and common bile duct (CBD) stones. The patient underwent an endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy, which led to the successful treatment of CBD stones. Three months after discharge, she underwent a CT-scan, which showed a regression of her pancreatitis (Balthazar grade D) with size reduction of the intra-abdominal collection. One month later, she came to the emergency department with abdominal pain, fever, and nausea. Blood tests showed an inflammatory syndrome with augmented C reactive protein (CRP) (300 mg/L) (normal
© HepatoBiliary Surgery and Nutrition. All rights reserved.
values:
Minimally invasive management of intrahepatic type II gallbladder perforation: a case report Dheidan Alshammari1, Riccardo Memeo1,2,3, Stylianos Tzedakis1, Julie Hargat1, Didier Mutter1,2,3, Jacques Marescaux1,2,3, Patrick Pessaux1,2,3 1
Department of Digestive Surgery, University Hospital of Strasbourg, Strasbourg, France; 2IRCAD, Research Institute Against Digestive Cancer,
Strasbourg, France; 3IHU-Strasbourg, Institute for Image-Guided Surgery, Strasbourg, France Correspondence to: Memeo Riccardo. Department of Digestive Surgery, University Hospital of Strasbourg, Strasbourg, 67000, France. Email: [email protected].
Abstract: Intrahepatic gallbladder perforation (GBP) is a rare medical entity, which creates a cholecystohepatic communication. We describe the case of a 70-year-old patient who presented with abdominal pain and a Niemeier type II GBP. This case report illustrates the minimally invasive management of a rare and life-threatening pathology. Keywords: Gallbladder perforation (GBP); laparoscopic cholecystectomy; Niemeier classification; percutaneous drainage Submitted Jul 21, 2015. Accepted for publication Jul 22, 2015. doi: 10.3978/j.issn.2304-3881.2015.08.02 View this article at: http://dx.doi.org/10.3978/j.issn.2304-3881.2015.08.02
Case presentation A 70-year-old woman was addressed to the emergency department with a right upper quadrant abdominal pain. The patient reported an increasing abdominal pain over the last 10 days, associated with nausea and vomiting. She was admitted to hospital 3 months earlier for acute pancreatitis. She had a Balthazar grade E pancreatitis secondary to gallstone disease with two peripancreatic collections. Her previous admission was also complicated by a septic shock, which required a short stay in the intensive care unit and treatment with antibiotics. Her septicemia was caused by a central venous catheter infection. During her hospital stay, a CT-scan demonstrated the presence of gallbladder (GB) and common bile duct (CBD) stones. The patient underwent an endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy, which led to the successful treatment of CBD stones. Three months after discharge, she underwent a CT-scan, which showed a regression of her pancreatitis (Balthazar grade D) with size reduction of the intra-abdominal collection. One month later, she came to the emergency department with abdominal pain, fever, and nausea. Blood tests showed an inflammatory syndrome with augmented C reactive protein (CRP) (300 mg/L) (normal
© HepatoBiliary Surgery and Nutrition. All rights reserved.
values:
