Abdur-Rahman Olajide Lukman, Adeniran Olaniyi James, Nasir Adegoke Abdul-Rasheed
Pediatric Surgery Unit, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
J Natl Med Assoc. 2009 Jul;101(7):717-9. doi: 10.1016/s0027-9684(15)30982-2.
Gallbladder perforation and gangrene ordinarily follow obstructive (calculous) cholecystitis with a higher frequency among immunocompromised patients or patients with intense inflammation of the gallbladder. The occurrence of typhoid intestinal perforation is common in the tropics, but GBP and gangrene have been reported sparingly. We report management challenges of 6 children with complications of acalculous cholecystitis from typhoid seen at our center.
The patients were retrospectively sorted from the pediatric surgery unit and theater records of January 2000 to December 2006. Information studied included the patients' biodata, presenting features, operative findings, and outcome of management.
There were 6 patients, including 5 boys and a girl, ages ranging 3 to 15 years. The general presentation was that of septicemia. Three had multiple gallbladder perforations, and 3 others had gallbladder gangrene with inflamed Payer's patches on the terminal ileum. All patients underwent open cholecystectomy. There was a case each of postoperative fecal fistula and biliary fistula. All patients survived.
Acalculous typhoid gallbladder perforation, though rare, presents with management challenges.
胆囊穿孔和坏疽通常继发于梗阻性（结石性）胆囊炎，在免疫功能低下患者或胆囊炎症剧烈的患者中发生率更高。伤寒性肠穿孔在热带地区很常见，但胆囊穿孔和坏疽的报道较少。我们报告了在我们中心看到的6例因伤寒导致无结石性胆囊炎并发症的儿童的治疗挑战。
对2000年1月至2006年12月小儿外科病房和手术室记录中的患者进行回顾性整理。研究的信息包括患者的生物数据、临床表现、手术发现和治疗结果。
共有6例患者，包括5名男孩和1名女孩，年龄在3至15岁之间。总体表现为败血症。3例有多处胆囊穿孔，另外3例有胆囊坏疽，回肠末端的派尔集合淋巴结发炎。所有患者均接受了开腹胆囊切除术。各有1例术后粪瘘和胆瘘。所有患者均存活。
无结石性伤寒性胆囊穿孔虽然罕见，但存在治疗挑战。
