Isolated Gall Bladder Perforation in a Tertiary Care Hospital in Eastern Nepal: A Descriptive Cross-sectional Study

Abstract

Introduction: Cholelithiasisis is a common surgical problem worldwide. Gall bladder perforation is a rare life-threatening complication with considerable mortality. This study aims to find the etiology, demography, type of perforation, and outcome of gall bladder perforation.

Methods: This descriptive cross-sectional study was done on patients above 18 years of age visiting the department of surgery of B. P. Koirala Institute of Health Sciences (BPKIHS) who were diagnosed with isolated gall bladder perforation. The study was done from 1st January 2006 till 30 December 2016. Ethical approval was obtained from the Institutional Review Committee (reference number. 34/074/075). The convenient sampling method was used. Data were entered in excel sheets and analyzed.

Results: Out of 49 patients included in the study, 28 (57.14%) were females and the commonest age group was 36 to 50 years 22 (44.9%) followed by 51 to 65 years 16 (32.6%). Most of the patients presented in emergency with pain in their abdomen. Diabetes mellitus was the commonest co-morbidity present in 10 (20.41%) patients. Operative management was done in 45 (91.84%) of the patient and conservative management in 4 (8.16%). After surgery of 45 patients, 43 (95.56%) improved and 2 (4.44%) expired. The most common type of perforation was Niemeier Type I in 21 (46.67%) followed by Type III 14 (31.11%). The most common histopathological diagnosis was acute cholecystitis 20 (44.44%).

Conclusions: Isolated gall bladder perforation is not an uncommon complication. The most common etiological factor was acute cholecystitis with a slight female predominance. Most of the patients needed surgical intervention and they had good outcomes when diagnosed and managed on time.