Risk factors for gallbladder perforation

Perforation of the gallbladder is a potentially lethal problem due in part to a delay in diagnosis. In an effort to improve our management of these patients, we reviewed all patients seen at the UCLA affiliated hospitals between 1955 and 1983 who had perforation of the gallbladder. Fifty-one patients were reviewed and perforations categorized as either acute (type I) in 16 (31%), subacute (type II) in 20 (39%), or chronic (type III) in 15 (29%). A history suggestive of chronic gallstone disease was obtained in 0% of patients with type I, in 35% of patients with type II, and 60% of patients with type III perforations. The incidence of severe systemic diseases was significantly greater (p less than 0.01) in patients with type I as compared to type III perforation. Based on 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.