Decoding the Enigma of Gallbladder Perforation: Exploring Patient Profiles, Diagnosis, and Step-Up Management Pathways.

BACKGROUND AND AIM

Gallbladder perforation (GBP) is a serious, life-threatening condition that can result from acute cholecystitis, trauma, or gallstone disease. Diagnosis remains challenging due to its nonspecific symptoms, often mimicking other abdominal pathologies. This study aimed to investigate the clinical features, diagnostic approaches, management strategies, and outcomes of GBP at a tertiary care center.

METHODS

A retrospective cohort study was conducted at Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital from January 2022 to February 2025. Patients aged 18 years and older diagnosed with GBP were included, with those with trauma or malignancy excluded. Demographic, clinical, diagnostic, and treatment data were collected and analyzed.

RESULTS

A total of 72 patients were included, predominantly aged >40 years (73.9%), with a higher prevalence in females (67.1%). Diabetes (26.1%) and hypertension (17.8%) were the most common comorbidities. The most frequent symptom was right upper quadrant pain (93%), with a mean presentation time of 18.6 days. Imaging (USG and CT) revealed that 67/72 cases were diagnosed with GBP, with the fundus being the most common site of perforation. Most patients (69.8%) received conservative management with antibiotics, while 16.6% underwent percutaneous drainage procedures. The overall mortality rate was 2.7%.

CONCLUSIONS

GBP presents with diverse clinical manifestations, and early diagnosis is crucial to reduce complications. Non-resolution of symptoms with significant pericholecystic collection warrants percutaneous drainage, a minimally invasive procedure with low morbidity. A multidisciplinary approach is essential for optimal management, particularly in complex cases requiring interval cholecystectomy.