Risk factors for perforation of gallbladder. A combined hospital study in a Chinese population

The composition and location of gallstones differ in Western and Eastern people. This has been documented in the literature. The difference in the clinical manifestations of biliary calculous disease has been postulated to be based on ethnic or environmental factors. In an effort to improve our management of patients with gallbladder perforations, a combined hospital study in a Chinese population during 11 years was conducted to study the clinical profiles at risk. Seventy-one patients were studied. The perforations were categorized as either acute (type I) in 14 (19.7%), subacute (type II) in 25 (35.2%), or chronic (type III) in 32 (45.1%). The incidence of severe underlying disease was significantly greater (p = 0.02) in patients with acute and subacute perforation as compared with chronic perforation. Multiple stones in the biliary tree and the gallbladder are very common and may mask the presentation of gallbladder perforation when patients with either biliary colic or biliary tract infection. A history suggestive of chronic gallstone disease is common, especially in patients with chronic perforation. The clinical manifestations of gallbladder perforation are similar to those of acute cholecystitis without perforation. On the basis of these data, clinical profiles have been developed for patients at risk of developing acute versus chronic gallbladder perforation. Awareness of these groupings forms the basis for early recognition and treatment of acute gallbladder perforation.