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Kawano K, Okazaki Y, Ichiba T. Potential complications of bevacizumab: gallbladder perforation. BMJ Case Rep 2025; 18:e265870. [PMID: 40355270 DOI: 10.1136/bcr-2025-265870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2025] Open
Affiliation(s)
- Kazuharu Kawano
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, Japan
| | - Yuji Okazaki
- Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, Japan
| | - Toshihisa Ichiba
- Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, Japan
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2
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Huang HW, Wang H, Leng C, Mei B. Formation and rupture of liver hematomas caused by intrahepatic gallbladder perforation: A case report and review of literature. World J Gastrointest Surg 2024; 16:3301-3311. [PMID: 39575284 PMCID: PMC11577401 DOI: 10.4240/wjgs.v16.i10.3301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 08/23/2024] [Accepted: 09/03/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND Gallbladder perforation is a serious complication of acute cholecystitis. Such perforation is a rare but life-threatening situation that can lead to the formation and rupture of liver hematomas. Here, we report a case of a ruptured intrahepatic hematoma caused by intrahepatic gallbladder perforation, and we present a literature review. CASE SUMMARY A 70-year-old male was admitted to the hospital with a complaint of right upper quadrant abdominal pain, flustering and dizziness. The preoperative diagnosis was a ruptured malignant liver tumor, and the patient's medical images and increased level of carbohydrate antigen-199 suggested that the gallbladder had been invaded. However, the tumor was proven to be a liver hematoma secondary to gallbladder perforation after surgery. The patient was discharged uneventfully on the fifteenth postoperative day. CONCLUSION Intrahepatic gallbladder perforation is difficult to diagnose preoperatively. Radiological examinations play a crucial role in the diagnosis but only for partial cases. Early diagnosis and appropriate surgery are key to managing this rare condition.
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Affiliation(s)
- Hong-Wei Huang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Hao Wang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Chao Leng
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Bin Mei
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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Quiroga-Garza A, Alvarez-Villalobos NA, Muñoz-Leija MA, Garcia-Campa M, Angeles-Mar HJ, Jacobo-Baca G, Elizondo-Omana RE, Guzman-Lopez S. Gallbladder perforation with fistulous communication. World J Gastrointest Surg 2023; 15:1191-1201. [PMID: 37405089 PMCID: PMC10315112 DOI: 10.4240/wjgs.v15.i6.1191] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/17/2023] [Accepted: 04/19/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND The management of gallbladder perforation (GBP) with fistulous communication (Neimeier type I) is controversial.
AIM To recommend management options for GBP with fistulous communication.
METHODS A systematic review of studies describing the management of Neimeier type I GBP was performed according to the PRISMA guidelines. The search strategy was conducted in Scopus, Web of Science, MEDLINE, and EMBASE (May 2022). Data extraction was obtained for patient characteristics, type of intervention, days of hospitalization (DoH), complications, and site of fistulous communication.
RESULTS A total of 54 patients (61% female) from case reports, series, and cohorts were included. The most frequent fistulous communication occurred in the abdominal wall. Patients from case reports/series had a similar proportion of complications between open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) (28.6 vs 12.5; P = 0.569). Mortality was higher in OC (14.3 vs 0.0; P = 0.467) but this proportion was given by only one patient. DoH were higher in OC (mean 26.3 d vs 6.6 d). There was no clear association between higher rates of complications of a given intervention in cohorts, and no mortality was observed.
CONCLUSION Surgeons must evaluate the advantages and disadvantages of the therapeutic options. OC and LC are adequate options for the surgical management of GBP, with no significant differences.
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Affiliation(s)
- Alejandro Quiroga-Garza
- Human Anatomy Department, Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey 64460, Nuevo Leon, Mexico
- General Surgery Division, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social, Monterrey 64000, Nuevo Leon, Mexico
| | - Neri Alejandro Alvarez-Villalobos
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic, Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey 64460, Nuevo Leon, Mexico
- Family Medicine Division, Instituto Mexicano del Seguro Social, Monterrey 64000, Nuevo Leon, Mexico
| | - Milton Alberto Muñoz-Leija
- Human Anatomy Department, Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey 64460, Nuevo Leon, Mexico
- Surgery Division, Hospital General de Zona No. 6, Instituto Mexicano del Seguro Social, Monterrey 64000, Nuevo Leon, Mexico
| | - Mariano Garcia-Campa
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic, Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey 64460, Nuevo Leon, Mexico
| | - Hermilo Jeptef Angeles-Mar
- Human Anatomy Department, Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey 64460, Nuevo Leon, Mexico
| | - Guillermo Jacobo-Baca
- Human Anatomy Department, Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey 64460, Nuevo Leon, Mexico
| | | | - Santos Guzman-Lopez
- Human Anatomy Department, Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey 64460, Nuevo Leon, Mexico
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Quiroga-Garza A, Alvarez-Villalobos NA, Angeles-Mar HJ, Garcia-Campa M, Muñoz-Leija MA, Salinas-Alvarez Y, Elizondo-Omaña RE, Guzmán-López S. Localized gallbladder perforation: a systematic review of treatment and prognosis. HPB (Oxford) 2021; 23:1639-1646. [PMID: 34246546 DOI: 10.1016/j.hpb.2021.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/27/2021] [Accepted: 06/03/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The optimal management of localized gallbladder perforation (Neimeier type II) has yet to be defined. The aim of this systematic review was to identify factors associated with improved patient outcomes. METHODS Systematic review of studies that described the management of Neimeier type II perforation, reported complications of the first intervention, necessity of added interventions, resolution of the pathology, and days of hospital stay were included. The search strategy was conducted in EMBASE, Mayo Journals, MEDLINE, SCOPUS, and Web of Science (December 2020) RESULTS: A total of 122 patients (53% male) from case reports, series, and cohorts were included for analysis. In total 56 (46%) and 44 (36%)patients were treated with open and laparoscopic cholecystectomy respectively. Overall risk of bias was moderate. The need for another intervention was higher in the laparoscopic group (5 vs 17, p=<0.001) as well as prevalence of complications (4 vs 16, p=<0.001), but lower for days of hospital stay (median days 5. vs 15, p = 0.008) against open cholecystectomy. Preoperative percutaneous catheter drainage did not influence outcome. CONCLUSION Open cholecystectomy has a lower need for further surgical procedures and postoperative complications, but a longer hospital stay. These outcomes did not vary with preoperative percutaneous drainage. The effect of timing of cholecystectomy did not influence the outcomes.
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Affiliation(s)
- Alejandro Quiroga-Garza
- Universidad Autónoma de Nuevo León, School of Medicine, Human Anatomy Department, Mexico; Instituto Mexicano Del Seguro Social, Delegación Nuevo Leon, Monterrey, Mexico
| | - Neri A Alvarez-Villalobos
- Instituto Mexicano Del Seguro Social, Delegación Nuevo Leon, Monterrey, Mexico; Universidad Autónoma de Nuevo León, School of Medicine, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Mexico
| | - Hermilo J Angeles-Mar
- Universidad Autónoma de Nuevo León, School of Medicine, Human Anatomy Department, Mexico
| | - Mariano Garcia-Campa
- Universidad Autónoma de Nuevo León, School of Medicine, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Mexico
| | - Milton A Muñoz-Leija
- Universidad Autónoma de Nuevo León, School of Medicine, Human Anatomy Department, Mexico
| | | | | | - Santos Guzmán-López
- Universidad Autónoma de Nuevo León, School of Medicine, Human Anatomy Department, Mexico.
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5
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Chikamori F, Yukishige S, Ueta K, Takasugi H, Mizobuchi K, Matsuoka H, Hokimoto N, Yamai H, Onishi K, Tanida N, Hamaguchi N, Iwasaki T. Hemoperitoneum and sepsis from transhepatic gallbladder perforation of acute cholecystitis: A case report. Radiol Case Rep 2020; 15:2241-2245. [PMID: 32952763 PMCID: PMC7486689 DOI: 10.1016/j.radcr.2020.08.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 11/05/2022] Open
Abstract
We report a case of hemoperitoneum and sepsis from transhepatic gallbladder perforation in an 87-year-old male with acute cholecystitis who had past history of endoscopic sphincterotomy for common bile duct stone. Contrast-enhanced computed tomography (CT) showed intrahepatic and subcapsular low density areas. A wall defect of gallbladder was seen in coronal and sagittal - sections at the liver bed. Fluids obtained through the paracentesis were hemorrhagic. Percutaneous transhepatic gallbladder drainage (PTGBD) was attempted. First cholangiography revealed an orifice of fistula. Further injection of contrast medium drained into the intrahepatic secondary abscess and intraperitoneal cavity confirming the diagnosis of transhepatic gallbladder perforation. We conclude that contrast-enhanced CT with coronal and sagittal - sections and cholangiography via PTGBD tube are useful to confirm diagnosis of transhepatic gallbladder perforation.
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Affiliation(s)
- Fumio Chikamori
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Sawaka Yukishige
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Koji Ueta
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Haruka Takasugi
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Kai Mizobuchi
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Hisashi Matsuoka
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Norihiro Hokimoto
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Hiromichi Yamai
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Kazuhisa Onishi
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Nobuyuki Tanida
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | | | - Takehiro Iwasaki
- Department of Gastroenterology, Japanese Red Cross Kochi Hospital, Kochi, Japan
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6
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Nikumbh T, Bhandarwar A, Sanap S, Wagholikar G. Laparoscopic management of intra-hepatic gallbladder perforation. J Minim Access Surg 2020; 16:77-79. [PMID: 30618436 PMCID: PMC6945341 DOI: 10.4103/jmas.jmas_267_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Intra-hepatic perforation of the gallbladder (GB) leading to hepatic abscess is a serious and rare complication of cholecystitis, with very few sporadically reported cases in the literature. Hence, there is no standard approach to treat it. A thorough radiological evaluation with computed tomography and endoscopic retrograde cholangiopancreatography is necessary before proceeding with surgery in such cases. An early laparoscopic intervention to perform a sub-total cholecystectomy with drain placement is enough to treat both cholecystitis and liver abscess in a definitive manner. While previous reports have advocated an open surgery, our series demonstrates that early laparoscopic management is a safe and suitable approach in such cases.
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Affiliation(s)
- Tejas Nikumbh
- Department of Surgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Ajay Bhandarwar
- Department of Surgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Shubhangi Sanap
- Department of Surgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Gajanan Wagholikar
- Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
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Würstle S, Göß A, Spinner CD, Huber W, Algül H, Schlag C, Schmid RM, Weber A, Obermeier A, Schneider J. A retrospective clinical and microbial analysis of 32 patients with bilomas. BMC Gastroenterol 2019; 19:50. [PMID: 30947689 PMCID: PMC6450004 DOI: 10.1186/s12876-019-0968-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bilomas are defined collections of bile fluids mainly caused by iatrogenic injuries of the bile duct system. Owing to the infrequency of this disease, studies addressing bilomas are rare. METHODS By using an endoscopic database, this retrospective study identified 32 patients with bilomas treated between 2004 to 2015, in order to analyse aetiology, clinical presentation, spectrum of pathogens, and resolution rate of bilomas. RESULTS 65.6% of the study population (21/32) developed bilomas after surgery and 21.9% (7/32) after endoscopic retrograde cholangiography (ERC). Icterus, fever, and abdominal pain were the leading symptoms. 93.9% (46/49) of microbiological bile cultures revealed a positive microbiology. The predominant microorganisms were the group of Enterobacteriaceae (43.0%, 52/121), followed by Enterococcus spp. (32.2%, 39/121), and Candida spp. (9.1%, 11/121). Multiresistant bacteria like Enterobacteriaceae were isolated from one quarter of all patients. Single or multimodal treatment resulted in an overall complication rate of 4.8% (9/188). Clinical follow-up analysis showed a complete resolution rate of 78.3% for interventional therapy and 80% in the non-interventional group. CONCLUSIONS Pathogen spectrum of bilomas mainly comprises the group of Enterobacteriacae and Enterococcus spp., with a high proportion of multiresistant bacteria. Different interventional approaches are available for biloma drainage, which seem to be safe and effective for most patients. TRIAL REGISTRATION German Clinical Trials Register DRKS00015208 , retrospectively registered.
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Affiliation(s)
- S Würstle
- Klinikum rechts der Isar, Technische Universität München, Innere Medizin II, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - A Göß
- Klinikum rechts der Isar, Technische Universität München, Innere Medizin II, Ismaningerstrasse 22, 81675, Munich, Germany
| | - C D Spinner
- Klinikum rechts der Isar, Technische Universität München, Innere Medizin II, Ismaningerstrasse 22, 81675, Munich, Germany
| | - W Huber
- Klinikum rechts der Isar, Technische Universität München, Innere Medizin II, Ismaningerstrasse 22, 81675, Munich, Germany
| | - H Algül
- Klinikum rechts der Isar, Technische Universität München, Innere Medizin II, Ismaningerstrasse 22, 81675, Munich, Germany
| | - C Schlag
- Klinikum rechts der Isar, Technische Universität München, Innere Medizin II, Ismaningerstrasse 22, 81675, Munich, Germany
| | - R M Schmid
- Klinikum rechts der Isar, Technische Universität München, Innere Medizin II, Ismaningerstrasse 22, 81675, Munich, Germany
| | - A Weber
- Klinikum rechts der Isar, Technische Universität München, Innere Medizin II, Ismaningerstrasse 22, 81675, Munich, Germany
| | - A Obermeier
- Klinikum rechts der Isar, Technische Universität München, Klinik für Orthopädie und Sportorthopädie, Implantat-assoziierte Infektforschung, Munich, Germany
| | - J Schneider
- Klinikum rechts der Isar, Technische Universität München, Innere Medizin II, Ismaningerstrasse 22, 81675, Munich, Germany
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8
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Hussain T, Adams M, Ahmed M, Arshad N, Solkar M. Intrahepatic perforation of the gallbladder causing liver abscesses: case studies and literature review of a rare complication. Ann R Coll Surg Engl 2016; 98:e88-91. [PMID: 27055407 PMCID: PMC5209960 DOI: 10.1308/rcsann.2016.0115] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2015] [Indexed: 11/22/2022] Open
Abstract
A spontaneous (non-traumatic) gallbladder perforation with gallstone disease is not common. Concomitant development of a liver abscess is a very rare complication observed in such cases. A few cases of intrahepatic gallbladder perforations with chronic liver abscesses have been described. However, a patient series summarising classical and atypical presentations, relevant imaging studies, and the role of surgical and non-surgical options are lacking. We report a short case series on this rare complication of intrahepatic gallbladder perforations and share our experience of management of this condition.
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Affiliation(s)
- T Hussain
- Salford Royal Hospital Foundation Trust , UK
| | - M Adams
- Tameside Hospital NHS Foundation Trust , UK
| | - M Ahmed
- Tameside Hospital NHS Foundation Trust , UK
| | - N Arshad
- Tameside Hospital NHS Foundation Trust , UK
| | - M Solkar
- Tameside Hospital NHS Foundation Trust , UK
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