Ann Ital Chir. 2020 Dec 3;91:S2239253X20032661.
Gallbladder perforation (GBP) is an uncommon life-threatening and almost exclusive complication of cholecystitis. It is often associated with relatively high morbidity and mortality rates due to delay in diagnosis. GBP still continues to be a challenging issue for the surgeons. Most cases can only be diagnosed during surgery. The aim of this retrospective, case series was to present our clinical experience with gallbladder perforation and to provide an overview of promoting factors, clinical manifestations, diagnostic workup and management of GBP on the basis of recent literature review.
This study involved four patients with gallbladder perforation (three males and one female), who were treated in our department from May 2019 to November 2019. We made a retrospective analysis of these patients and a review of the related literature.
According to Niemeier's classification, all patients had type II gallbladder perforation. Mean age was 70 years (range 50-85 years). They had also significant comorbidities, of which diabetes mellitus was the most common (three patients). Ultrasonography was the initial mode of investigation in these four patients. Out of the four cases, three patients underwent immediate intervention and only one patient was initially managed conservatively with intravenous antibiotics.
Early diagnosis of gallbladder perforation and immediate intervention are of crucial importance. Clinical examination, diagnostic imaging and high index of suspicion of this severe condition would be significant in establishing an early diagnosis of the perforation.
Cholecystitis, Gallbladder perforation, Niemeier.
胆囊穿孔（GBP）是胆囊炎罕见的危及生命的并发症，几乎是其唯一的并发症。由于诊断延迟，常伴有较高的发病率和死亡率。GBP 仍然是外科医生面临的一个挑战。大多数病例只能在手术中诊断。本回顾性病例系列的目的是介绍我们在胆囊穿孔方面的临床经验，并根据最近的文献复习，概述促进因素、临床表现、诊断方法和 GBP 的治疗。
本研究纳入了 2019 年 5 月至 2019 年 11 月在我科治疗的 4 例胆囊穿孔患者（3 例男性，1 例女性）。我们对这些患者进行了回顾性分析，并对相关文献进行了复习。
根据 Niemeier 分类，所有患者均为 II 型胆囊穿孔。平均年龄为 70 岁（50-85 岁）。他们还存在显著的合并症，其中糖尿病最常见（3 例）。这 4 例患者最初均行超声检查。这 4 例患者中，3 例行立即干预，仅 1 例最初接受静脉抗生素保守治疗。
早期诊断和及时干预至关重要。临床检查、诊断影像学和对这种严重情况的高度怀疑，对于建立穿孔的早期诊断具有重要意义。
胆囊炎；胆囊穿孔；Niemeier
