Perforation of the gallbladder diagnosed preoperatively

Area of Science:

• Gastroenterology
• Nuclear Medicine
• Diagnostic Imaging

Background:

• Acute cholecystitis is a common surgical emergency.
• Gallbladder perforation is a rare but serious complication.
• Traditional diagnostic methods like ultrasonography and oral cholecystography can be inconclusive for perforation.

Observation:

• A 69-year-old male presented with symptoms suggestive of acute cholecystitis.
• Initial ultrasonogram and oral cholecystogram were negative for acute cholecystitis.
• A technetium-99m-PIPIDA (iminodiacetic acid) hepatobiliary scan revealed gallbladder perforation.

Findings:

• The hepatobiliary scan demonstrated radiolabeled bile leakage into the abdominal cavity, confirming perforation.
• Surgical exploration immediately following the scan validated the diagnosis of gallbladder perforation.
• Technetium-99m-PIPIDA scanning proved highly effective in diagnosing gallbladder perforation when other methods failed.

Implications:

• Technetium-99m-PIPIDA hepatobiliary scintigraphy should be considered a primary diagnostic tool for patients at high risk of gallbladder perforation.
• Early and accurate diagnosis of gallbladder perforation can lead to timely surgical intervention and improved patient outcomes.
• This imaging modality offers a valuable alternative for diagnosing gallbladder pathology when conventional methods are insufficient.