Gallbladder perforation: diagnostic utility of cholescintigraphy in suggested subacute or chronic cases

The preoperative cholescintigrams of 16 patients with subacute or chronic gallbladder (GB) perforation demonstrated at surgery were reviewed, and the scintigraphic findings were characterized. Persistent GB nonvisualization was found in each study. Additional findings included a band of increased pericholecystic hepatic activity (PCHA) (n = 7) and/or a photopenic region in the GB fossa (n = 7). PCHA and photopenic region findings, when visualized, were most commonly associated with a subacute localized perforation with pericholecystic abscess formation. However, the sensitivity of each of these findings was only 44%. Cholescintigrams did not directly demonstrate the perforation site in any patient. Although the presence of the PCHA sign and/or GB fossa photopenic region appears to identify a subgroup of patients at increased risk for perforation, cholescintigraphy is relatively insensitive for detection of subacute or chronic GB perforation.