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COMMENTARY |
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Year : 2014 | Volume
: 6
| Issue : 1 | Page : 45 |
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Conservative treatment of gall bladder perforation is not the standard
Berthold Gerdes, Jerzy Laniewsky, Oke Akkermann
Department of General Visceral and Thoracic Surgery and Laparoscopic Surgery, G-32429 Minden, Germany
Date of Web Publication | 24-Jun-2014 |
Correspondence Address: Berthold Gerdes Department of General Visceral and Thoracic Surgery and Laparoscopic Surgery, G-32429 Minden Germany
Source of Support: None, Conflict of Interest: None
PMID: 25013555
How to cite this article: Gerdes B, Laniewsky J, Akkermann O. Conservative treatment of gall bladder perforation is not the standard. J Surg Tech Case Report 2014;6:45 |
How to cite this URL: Gerdes B, Laniewsky J, Akkermann O. Conservative treatment of gall bladder perforation is not the standard. J Surg Tech Case Report [serial online] 2014 [cited 2016 May 10];6:45. Available from: http://www.jstcr.org/text.asp?2014/6/1/45/135166 |
We congratulate the authors to this case report, the first description of a successful non-operative management of a traumatic gall bladder perforation. They show that this management is possible in a special situation. However, feasibility is not the relevant question. Medical decisions have to minimize the risk of the patient. Therefore, we have not to ask if non-operative management of traumatic gall bladder perforation is possible, but we have to ask, if it is safe. Following diagnosis of a gall bladder perforation laparoscopic verification and cholecystectomy is a safe procedure in most patients. [1] In cases with isolated traumatic gall bladder perforation, patients suffer of peritonitis sometimes with a long oligosymptomatic interval. [2] In a review of the literature, Jaggard et al. identified free fluid and mild clinical signs of peritonitis following blunt abdominal trauma to be suspicious for this rare injury, reported to be between 1.9% and 2.1% of all abdominal traumas. After discussing the available evidence, the authors advocate a low index of suspicion for performing diagnostic laparoscopy, especially since the incidence of associated visceral injuries in gallbladder trauma is greater than 90%. [3] Most patients with non-treated biliary peritonitis become severely ill due to supervening infection while early bile drainage avoids serious complications. [4] In conclusion, the described conservative treatment of a traumatic gall bladder perforation is not the standard treatment. Diagnostic laparoscopy, lavage, drainage of the peritoneal cavity with laparoscopic cholecystectomy seems to be a good procedure for these patients.
References | | |
1. | Kohler R, Millin R, Bonner B, Louw A. Laparoscopic treatment of an isolated gallbladder rupture following blunt abdominal trauma in a schoolboy rugby player. Br J Sports Med 2002;36:378-9. |
2. | Alderi G, Monguzzi A, Ricci M. Two-time traumatic rupture of the gallbladder. Minerva Chir 1980;35:263-6. [PUBMED] |
3. | Jaggard MK, Johal NS, Choudhry M. Blunt abdominal trauma resulting in gallbladder injury: A review with emphasis on pediatrics. J Trauma 2011;70:1005-10. |
4. | Gabriele R, Bolognese A, De Toma G, Impara L, Conte M, Di Cello P, et al. Analysis of variables predictive of severity in biliary peritonitis. Ann Ital Chir 2012;83:445-9. |
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