Department of Hepatobiliary Surgery, Xiaolan People's Hospital of Zhongshan (The Fifth People's Hospital of Zhongshan), Zhongshan, Guangdong Province, China.
J Int Med Res. 2024 Jun;52(6):3000605241257452. doi: 10.1177/03000605241257452.
Niemeier type II gallbladder perforation (GBP) is caused by inflammation and necrosis of the gallbladder wall followed by bile spilling into the abdominal cavity after perforation. The gallbladder then becomes adhered to the surrounding inflammatory tissue to form a purulent envelope, which communicates with the gallbladder. At present, the clinical characteristics and treatment of type II GBP are not well understood and management of GBP remains controversial. Type II GBP with gastric outlet obstruction is rare and prone to misdiagnosis and delayed treatment. Recent systematic reviews report that percutaneous drainage does not influence outcomes. In this current case, due to the high risk of bleeding and accidental injury, as well as a lack of access to safely visualize the Calot's triangle, the patient could not undergo laparoscopic cholecystectomy, which would have been the ideal option. This current case report presents the use of percutaneous laparoscopic drainage combined with percutaneous transhepatic gallbladder drainage in a patient with type II GBP associated with gastric outlet obstruction. A review of the relevant literature has been provided in addition to a summary of the clinical manifestations and treatments for type II GBP.
尼迈耶尔 II 型胆囊穿孔（GBP）是由胆囊壁炎症和坏死引起的，穿孔后胆汁溢出到腹腔。然后，胆囊与周围炎症组织粘连形成脓性包膜，并与胆囊相通。目前，对 II 型 GBP 的临床特征和治疗尚不完全了解，GBP 的处理仍存在争议。伴有胃出口梗阻的 II 型 GBP 较为罕见，易误诊和延迟治疗。最近的系统评价报告称，经皮引流不会影响结果。在本病例中，由于出血和意外损伤的风险较高，以及无法安全地观察到胆囊三角，因此不能进行腹腔镜胆囊切除术，这本来是理想的选择。本病例报告介绍了在伴有胃出口梗阻的 II 型 GBP 患者中使用经皮腹腔镜引流联合经皮经肝胆囊引流的方法。此外，还对相关文献进行了复习，并总结了 II 型 GBP 的临床表现和治疗方法。
