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Basic laparoscopy: Cholecystectomy 04.3.1.5 Localised perforation of gallbladder

If a gallbladder perforates within 6 - 12 hours of the onset of ultra acute cholecystitis, there is no time for the body's defences

to come into play.

If the pace of the condition is slower, there is time for the local tissue to respond to localise the perforation.

The surrounding structures become inflamed and adhere to the gallbladder.

These include:

Omentum.

Duodenum.

Small and large bowel.

Anterior abdominal wall.

Liver

This has the effect of confining a leakage of gallbladder contents to just around the gallbladder itself.

Healing by fibrosis may make the tissues very tough to dissect.

The tissue planes are likely to be obliterated.

The patient is likely to have been unwell for 2 to 4 weeks with a localised perforation.

Adhesions are likely to be very dense and be permanent.

Conversion from a laparoscopic to an open cholecystectomy is more likely than usual.

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