TWO CASES OF IDIOPATHIC PERFORATION OF THE GALLBLADDER

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Two cases of idiopathic perforation of the gallbladder are reported. Patient 1, a 74-year-old man was admitted to the hospital because of epigastralgia. On admission, he had a sign of peritonitis. Abdominal computed tomography (CT) showed free air. An emergency operation was performed under the diagnosis of perforating duodenal ulcer. At surgery, ascites and two perforations of the gallbladder were seen. Cholecystectomy and abdominal drainage were performed. Patient 2, an 82-year-old man was admitted to the hospital because of stomachache and abdominal fullness. On admission, abdominal X-rays showed a lot of stool and the extended colon. After hospitalization he had a sign of peritonitis and abdominal CT scan showed ascites. The patient was operated on under the diagnosis of panper-itonitis. At surgery, there were much ascites, a perforation of the gallbladder, and prominent dilatation of intestine to the rectum from transverse colon, mega colon being accepted. Cholecystectomy, abdominal drainage and colonostomy were performed. Resected specimen from the two cases showed no gallstone, but inflammatory changes of the gallbladder wall and necrotic changes covering all layers in part were observed. Idiopathic perforation of the gallbladder is comparatively rare and 40 cases have been reported in Japan. We present two our cases, together with bibliographical comments.
日本臨床外科学会の論文