Anderson B B, Nazem A
J Natl Med Assoc. 1987 Apr;79(4):393-9.
Experiences with seven cases of gallbladder perforation managed in Kingston, Jamaica, at the District of Columbia General Hospital, and other Howard University affiliated hospitals are presented. The results of a review of 197 consecutive biliary operations at DC General Hospital for occurrence of this entity are presented.Gallbladder perforation is a complication of cholecystitis in 1 to 4 percent of cases. Niemeier(1) classified this complication in three types in 1934, and currently these are described as type 1-free perforation, type 2-perforation with abscess, and type 3-chronic perforation with cholecysto-enteric fistula.The gallbladder may, in extremely unusual occurrences, perforate into the biliary tree itself with significant operative implications, and therefore Niemeier's classification can be modified to include cholecystobiliary fistuale formation as type 4. Seven case reports manifesting all four types of perforation are presented, representing the spectrum of current treatment and diagnostic options.
本文介绍了在牙买加金斯敦的哥伦比亚特区综合医院以及其他霍华德大学附属医院处理的7例胆囊穿孔病例的经验。文中还给出了对哥伦比亚特区综合医院连续197例胆道手术中该病症发生率的回顾结果。胆囊穿孔是胆囊炎1%至4%病例中的一种并发症。1934年，尼迈尔（1）将这种并发症分为三种类型，目前这些类型被描述为1型——游离穿孔，2型——伴有脓肿的穿孔，3型——伴有胆囊肠瘘的慢性穿孔。在极为罕见的情况下，胆囊可能会穿孔进入胆道系统本身，这具有重大的手术意义，因此尼迈尔的分类可修改为包括将胆囊胆管瘘形成列为4型。本文呈现了体现所有四种穿孔类型的7例病例报告，代表了当前的治疗和诊断选择范围。
