Gallbladder perforation: risk factors and outcome.

BACKGROUND: Gallbladder perforation is difficult to diagnose and is associated with significant morbidity. This study investigates factors affecting outcome in patients with gallbladder perforation over two decades.

MATERIALS AND METHODS: From 1982 to 2002 data from patients undergoing cholecystectomy at one institution were prospectively collected. Patients treated for gallbladder perforation and gangrenous cholecystitis were identified and outcomes were compared. The chi(2) test, Student's t-test, and Mann-Whitney rank sum test were used for statistical analysis.

RESULTS: Two hundred eight of 11,360 patients who underwent cholecystectomy were diagnosed with gangrenous cholecystitis and 30 were diagnosed with gallbladder perforation. The perforation was contained in 9 and free in 21 patients. The diagnosis of gallbladder perforation was made preoperatively in 3% of patients. Men outnumbered women and Hispanics outnumbered Caucasians. Compared to patients with gangrenous cholecystitis, patients with gallbladder perforation presented at an older age (53 versus 60 years; P < 0.05), had more cardiovascular comorbidity (29% versus 50%; P < 0.05) and postoperative complications (19% versus 37%; P < 0.05), and required more ICU admissions (9% versus 33%; P < 0.001) and longer hospital stays (8 versus 13 days; P < 0.001). Early cholecystectomy within 24 h improved outcome (P < 0.05).

CONCLUSIONS: Gallbladder perforation is a rare complication of cholelithiasis that occurs more often in men, Hispanics, and older patients. It is rarely diagnosed preoperatively. Late operative intervention is associated with increased morbidity, mortality, number of ICU admissions, and long postoperative hospital stays. An early cholecystectomy strategy may lead to improved outcomes but may be difficult to implement and may not be cost-effective.