GALLBLADDER PERFORATION: DIAGNOSIS AND TACTICS OF SURGICAL TREATMENT

Abstract. Acute cholecystitis develops in 1-3 % of patients with symptomatic gallstones. Gallbladder perforation is found in 2-11 % of cases of acute cholecystitis. Aim. To determine the diagnostic criteria of different types of perforation of the gallbladder in acute cholecystitis. Materials and methods. A retrospective analysis of the results of surgical treatment of 75 patients with gallbladder perforation was conducted. Patients with gallbladder perforation accounted for 4.5 % of patients operated on for acute cholecystitis. There were 38 (50.7 %) men, 37 (49.3 %) women. The average age was 65 years. Results and discussion. Perforation of the first type according to Niemeier was diagnosed in 13 (17.3 %) patients, the second — in 58 (77.3 %), the second type in combination with the third — in 4 (5.3 %). Patients came with acute cholecystitis Grade II according to TG 13 – 67 (89.3 %) patients, Grade III – 8 (10.7 %). Laparoscopic technologies were used in 14 (18.7 %), open surgical interventions were performed in 61 (81.3 %) patients. Postoperative complications were observed in 15 (20 %): Grade II — in 4 (5.3 %), Grade IIIb — in 10 (13.3 %), Grade IV — in 1 (1.3). Died — 4 (5.3 %). Conclusions. Gallbladder perforation occurs in 4.5 % of patients with acute cholecystitis, most often in elderly and senile patients - 68 %. In 17.3 % there is perforation of type II according to Niemeier, in 77.3 % — perforation of type II, in 5.4 % — a combination of perforation II and III. The clinical picture of perforation of the gallbladder corresponds to the symptoms of acute cholecystitis Grade II — in 89.3 %, Grade III — in 10.7 % according to TG 13. Accurate diagnosis of the type of perforation is possible during surgical treatment. Patients with perforation of the gallbladder require urgent surgical treatment, while laparoscopic technologies are possible in 18.7 %, open surgical interventions — in 81.3 %