Sharma Ankush, Jariwala Priyansh, Kaur Navneet
1 Senior Resident, University College of Medical Sciences & Guru Teg Bahadur Hospital, New Delhi, India.
2 Postgraduate, University College of Medical Sciences & Guru Teg Bahadur Hospital, New Delhi, India.
Trop Doct. 2018 Jul;48(3):242-245. doi: 10.1177/0049475518768103. Epub 2018 Apr 13.
The most common cause of gallbladder perforation is calculous cholecystitis. Rarer causes include trauma, iatrogenic injuries, biliary stasis and gall bladder ischemia. We report a case of gall bladder gangrene with perforation, secondary to extensive ascariasis. A 45-year-old woman presented with acute intestinal obstruction and jaundice. She had abdominal distension and right hypochondrial tenderness. Abdominal radiography showed dilated bowel loops and ultrasonogram showed worms in the small intestine and biliary tree. On exploration, a bolus of worms 2 feet proximal to the ileocaecal junction was found causing obstruction. Worms were also present in the bile duct and gallbladder causing gangrene and perforation. She underwent cholecystectomy, bile-duct exploration and enterotomy. However, she died on the third postoperative day of overwhelming sepsis. Enteric complications of ascaris leading to bowel obstruction are well-known. Hepatobiliary complications such as cholangitis and obstructive jaundice are rare. However, such an extreme degree of infestation leading to gangrene and perforation of the gall bladder is extremely rare.
胆囊穿孔最常见的原因是结石性胆囊炎。较罕见的原因包括外伤、医源性损伤、胆汁淤积和胆囊缺血。我们报告一例广泛蛔虫感染继发胆囊坏疽并穿孔的病例。一名45岁女性因急性肠梗阻和黄疸就诊。她有腹胀和右季肋部压痛。腹部X线片显示肠袢扩张，超声检查显示小肠和胆管内有蛔虫。术中探查发现，在回盲部近端2英尺处有一团蛔虫导致梗阻。胆管和胆囊内也有蛔虫，引起坏疽和穿孔。她接受了胆囊切除术、胆管探查术和肠切开术。然而，她在术后第三天死于严重脓毒症。蛔虫引起的肠道并发症导致肠梗阻是众所周知的。肝胆并发症如胆管炎和梗阻性黄疸则较为罕见。然而，如此严重的感染程度导致胆囊坏疽和穿孔极为罕见。
