PDF(Pubmed)
Abstract：
Gallbladder perforation is a rare complication of acute cholecystitis that is associated with significant morbidity and mortality. Many cases of gallbladder perforation are not diagnosed until surgery, as the physical symptoms closely mimic acute cholecystitis. Gallbladder perforation is most common among older males with associated comorbidities, and preoperative assessment of comorbidities, particularly cardiac, is critical to determine the appropriate clinical course. We report a case of a 77-year-old male who presented initially with low blood pressure and right upper quadrant pain (RUQ) after not feeling well for five days. CT of the abdomen/pelvis with IV contrast demonstrated acute perforated cholecystitis, and general surgery was consulted for a cholecystectomy. Due to the patient\'s past medical history of severe aortic stenosis (AS), cholecystectomy was deferred and a cholecystostomy tube was placed by interventional radiology. This report aims to provide an example of a case of perforated cholecystitis with sepsis and how it can be diagnosed and managed non-surgically in the presence of pre-existing severe AS.
摘要：
胆囊穿孔是急性胆囊炎的罕见并发症，与显著的发病率和死亡率相关。许多胆囊穿孔病例直到手术后才被诊断出来,作为身体症状紧密模仿急性胆囊炎。胆囊穿孔在伴有合并症的老年男性中最常见，术前评估合并症，尤其是心脏,对于确定适当的临床过程至关重要。我们报告了一例77岁的男性，该男性在感觉不舒服五天后最初出现低血压和右上腹疼痛（RUQ）。腹部/骨盆CT静脉造影显示急性穿孔性胆囊炎，并咨询了普外科手术进行胆囊切除术。由于患者的严重主动脉瓣狭窄（AS）病史，我们推迟了胆囊切除术，并通过介入放射学放置了胆囊造口管。本报告旨在提供一例穿孔性胆囊炎伴脓毒症的病例，以及在存在已有严重AS的情况下，如何通过非手术方式对其进行诊断和治疗。
