Gallbladder disease is a common problem, mostly associated with gallstones and inflammation of gallbladder. Gallbladder as we all know is a pear shaped sac underneath the liver which stores bile, vital chemical to breakdown fat from the food we eat.
Rupture of gallbladder is uncommon, but is serious condition which requires immediate medical attention. It is life-threatening condition. Perforation can occur due to large impacted gallstone, inflammation or due to traumatic injury to the abdomen.
The cardinal symptoms of gallbladder rupture is sudden and severe pain in right upper abdomen, vomiting, bloating of abdomen.If left untreated it can lead to septicemia a dangerous medical condition having high mortality rate. Ruptured gallbladder needs to be removed surgically. At the same time antibiotics and other treatment measures may be necessary to treat septicemia if the bile has spilled into the abdominal cavity.
Causes Of Gallbladder Rupture
Rupture or perforation of gallbladder occurs when there is necrosis or gangrene of the portion of wall of the gallbladder. Reduced blood circulation to gallbladder due to hardening or compression of the artery supplying blood to gallbladder may cause necrosis and gangrene.
Inflammation of the sac that occurs due to gallstone or infection is one of the reasons. Blunt injury or sharp penetrating wound is another major cause of gallbladder perforation. Below are leading risk factors for rupture of gallbladder.
- Inflammation due to large impacted gallstone.
- Bacterial infection in gallbladder. The usual causative pathogens are E. Coli, streptococcus bacteria, Klebsiella.
- Sometimes ascaris lumbricoid a long parasitic intestinal worm may migrate into the gallbladder. It can cause perforation of the gallbladder.
- Blunt injury from motor vehicle accidents, a direct blow over right upper side of abdomen can lead to rupture of gallbladder.
Signs And Symptoms Of Gallbladder Rupture
The symptoms of gallbladder perforation are often confusing as they may be similar to those of gallstones or acute inflammation of gallbladder (cholecystitis).
- Severe and sudden pain in right upper part of abdomen. Pain radiates to back and right shoulder.
- Associated nausea and vomiting.
- Tenderness on right side of abdomen. Later on the whole abdomen is tender to touch.
- Patient is unable to walk straight and has to lean forward due to pain in abdomen.
- Rapid pulse and low blood pressure.
- Skin and extremities are cool to touch due to shock resulting from sepsis.
- Poor general condition of the patient.
Many patients have previous history of gallstone pain and cholecystitis. However, this may not be so in case of perforation of gallbladder resulting from injury.
Diagnosis And Treatment Of Ruptured Gallbladder
Diagnosis: Early diagnosis of perforated gallbladder at times is difficult for the physician. Secondly rupture is infrequent in gallbladder disease. The symptoms of perforation are similar to those of acute cholecystitis. Doctors therefore recommend diagnostic tests so that the exact pathology is revealed. Tests such as ultrasound of abdomen, CT scan or MRI, blood tests such as ESR, C-reactive protein helps in indicating if inflammation or infection is present.
Gallbladder rupture is potentially life-threatening condition. Patient has to be hospitalized as early as possible. The bile that is stored in gallbladder spills in the abdomen due to rupture. This may cause peritonitis, a serious medical condition leading to sepsis. Emergency surgery may be required to remove gallbladder and clean the peritoneum that lines the abdominal organs.
At the same time antibiotics, intravenous fluid and other emergency measures are used. After removal of gallbladder patient may need to stay in the hospital for few days until all vital parameters such as pulse, blood pressure is back to normal.