Biliary System
Last updated (28 October 2003)
Good Stuff
Spot Diagnosis
Biliary System
Padding space Perforated Gallbladder
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Perforated Gallbladder Click on the image to download a larger version
The gallbladder has been removed from the patient, a single large gallstone has been pushed out of Hartman's pouch into the fundus.
Is this the usual site where a gallbladder perforates?
What may have caused the perforation, in this instance?
This is the most common site
The gallbladder usually perforates in the fundus
This perforation was most likely due to micro embolisation
This perforation was most likley due to the gallstone

The answer

This is not the most usual site of a gallbladder perforation. Perforations are most common in the fundus. In this case the perforation most likely was due to pressure from the impacted stone on the wall of the gallbladder.

What the student may say

No, this is not the most common location of a gallbladder perforation. The gallbladder is most liable to perforation in the fundus, where the blood supply is poorest. Perforation in the fundus usually occurs in the context of a severe attack of cholecystitis which progresses to gangrenous cholecystitis. In this particular patient the perforation was most likely due to a pressure induced necrosis of the site of the perforation, due to the effects of the impacted gall stone.

Small print

This is not the most common site, the most common site is the fundus. The fundus has the poorest blood supply and in patients with severe cholecystitis who progress to gangrenous cholecystitis, the fundus is the most likely site of perforation.

This perforation is not most likely due to micro embolisation. Spontaneous perforations in the gallbladder are in the main due to

Traumatic perforations of the gall-bladder occur;

Adrian P. Ireland