A gallbladder breakthrough with bile leakage is also known as perforation or rupture of the gallbladder, which can lead to severe pain and a life-threatening condition. The tearing is usually the result of acute gallbladder inflammation due to gallstones with damage to the gallbladder wall. There is often a covered breakthrough, less often a free perforation. In the latter variant, dangerous peritonitis develops in many cases. Diagnosis is often difficult, but prompt surgery to remove the gallbladder can save lives.
Gallbladder perforation (also called gallbladder rupture) is a relatively rare but life-threatening complication that can occur as a result of various diseases of the gallbladder. There is often a connection to acute gallbladder infection (cholecystitis) due to gallstones. Damage to the gallbladder wall rips it and leaks bile from the gallbladder. A basic distinction is made between the two different forms of covered and free perforation. The covered ruptures occur more frequently overall.
A still used Niemeier classification from 1934 divides the gallbladder perforation into the following three types:
- Type I: Acute free perforation in the abdominal cavity.
- Type II: Subacute perforation with pericholecystic abscess.
- Type III: Chronic perforation with formation of an enterocholecystic fistula.
Symptoms that may indicate a gallbladder breakthrough include a rapidly worsening general condition with high fever. In addition, there are severe pains (biliary pain), which - similar to inflammation of the gall bladder - manifest primarily in the right upper abdomen (upper abdominal pain). In technical jargon, this type of pain is also known as defense tension. You may also experience nausea and vomiting.
With free gallbladder perforation, the bile passes into the free abdominal cavity. If there is an acute inflammation of the organ, the peritoneum inflammation (bilious peritonitis) with an acute abdomen often occurs due to the leaked bacteria.
Covered perforation can also be asymptomatic, which makes diagnosis much more difficult and can lead to dangerous delays.
A gallbladder tears mostly due to strong pressure on a damaged gallbladder wall. Gallstones, which prevent the gallbladder from escaping and the drainage of the bile, can lead to acute cholecystitis. In the further course of the disease, the gallbladder becomes dilated (empyema), serious tissue damage due to a reduced blood supply (gangrene) or an enlargement of the gallbladder due to the obstructed bile drainage (gall stasis and gallbladder hydration). All of this can bring about a breakthrough.
In older people, the risk factors also include systemic comorbidities (e.g. diabetes) and immunosuppression.
The diagnosis is fundamentally very difficult. Ultrasound examinations or other imaging methods cannot always make a perforation visible. Computed tomography is generally regarded as the best method for preoperative detection.
Blood tests usually show increased inflammation values.
If the gallbladder is known to have a pre-existing condition or if there is a known acute inflammation, a breakthrough can be expected in about two to eleven percent of cases. Often, however, the complication is only confirmed during an indicated surgical procedure.
An early diagnosis with an immediate surgical intervention is believed to have the best chance of a cure.
Due to the acute life-threatening condition, the therapy basically consists in the surgical removal of the gallbladder (cholecystectomy). A minimally invasive laparoscopic procedure is usually performed using a small incision in the abdominal wall.
After a survived cholecystectomy and the time of follow-up care, no special diet needs to be followed. However, very fatty foods are difficult to digest and diarrhea can occur after eating fatty foods. A balanced, low-fat diet with small meals can therefore contribute to well-being and long-term health. (jvs, cs)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. rer. nat. Corinna Schultheis
- Pschyrembel: Clinical dictionary. 267th, revised edition, De Gruyter, 2017
- Professional association of German internists (ed.): Www.internisten-im-netz.de - gallbladder inflammation (available on 10.07.2019), internisten-im-netz
- Hauser, Hubert, Buhr, Heinz Johannes, Mischinger Hans-Jörg (ed.): Acute abdomen. Diagnosis - differential diagnosis - primary care - therapy, Springer Verlag, 2016
- Derici, H et al .: Diagnosis and treatment of gallbladder perforation, in: World Journal of Gastroenterology, edition 12/48 (2006): 7832-7836, wjgnet.com
ICD codes for this disease: K82.2ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.