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      • Record: found
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      Green dialysate and gallbladder perforation in a peritoneal dialysis patients: a case report and literature review

      case-report

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          Abstract

          Background

          Gallbladder perforation is a rare but lethal condition and its diagnosis is usually difficult and delayed. Frequently, gallbladder rupture is associated with cholecystitis, but spontaneous perforation was ever described. However, spontaneous rupture of gallbladder has never been reported in patients underwent peritoneal dialysis.

          Case presentation

          We report a 62-year-old man who presented with abdominal pain for 2 days to clinic. Peritoneal dialysis-related peritonitis was diagnosed initially. It was followed by spontaneous gallbladder perforation with greenish dialysate. The patient was managed successfully by antibiotic treatment and primary closure of gallbladder perforation with external drainage. He recovered from this critical condition and stayed on dialysis.

          Conclusions

          Early diagnosis and timely surgical intervention yields a good prognosis in PD patients with gallbladder perforation. Surgical intervention and antibiotic treatment are the mainstay of treatment. Both of them should take place promptly.

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          Most cited references33

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          Acute Free Perforation of the Gall-Bladder.

          O W Niemeier (1934)
          Article 0 comments Cited 39 times – based on 0 reviews     Review now
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            Factors effecting the complications in the natural history of acute cholecystitis.

            A Bedirli, O Sakrak, E M Sözüer … (2015)
            Gangrenous cholecystitis, empyema, gallbladder perforation, and biliary peritonitis are severe complications of acute cholecystitis associated with increased morbidity and mortality. This study aimed to evaluate perioperative factors associated with complications of acute cholecystitis. Between January 1993 and October 2000, we performed cholecystectomy in 368 patients with acute cholecystitis. All perioperative data were collected on age, sex, medical history, symptoms, laboratory tests, ultrasound, operative and microbiological findings, morbidity and mortality. There were 305 cases (83%) of acute uncomplicated cholecystitis, 26 (7.1%) of gangrenous cholecystitis, 23 (6.3%) of empyema of the gallbladder, 12 (3.3%) of gallblader perforation, and 2 (0.5%) emphysematous cholecystitis. Risk factors for complicated cholecystitis included male gender, advanced age, associated diseases, temperature above 38 degrees C, and white blood cell count on admission greater than 18,000. Laparoscopic cholecystectomy was attempted on 36 patients (11.8%) with uncomplicated and seven patients (11.1%) with complicated acute cholecystitis. The conversion rate to open cholecystectomy was 19.4% for uncomplicated cases, 28.6% for complicated cases. There were no differences in operative complications between complicated and uncomplicated cases, however, length of hospital stay, postoperative morbidity and mortality were significantly higher in complicated cases. Sex (male), advanced age, presence of associated disease, high temperature (> 38 degrees C) and leukocytosis are all remarkable risk factors inducing complications in acute cholecystitis. Laparoscopic cholecystectomy can be performed with success in uncomplicated cases.
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              Hemoperitoneum in patients with ascites.

              E A Akriviadis (1997)
              To review existing data on the pathophysiology and clinical presentation of hemoperitoneum in patients with ascites and to familiarize practicing clinicians who take care of such patients with the therapeutic options currently available for management of this complication. Relevant English-language articles published between January 1988 and November 1996 were identified through MEDLINE search, using the key words "hemoperitoneum" and "ascites." Articles cited in the bibliographies of these articles were searched manually. Published papers that contained data on hemoperitoneum in general and on hemoperitoneum developing in patients with ascites were reviewed. In patients with ascites, hemoperitoneum can develop spontaneously or can follow abdominal trauma and diagnostic or therapeutic procedures. Spontaneous bleeding into ascites usually develops insidiously and may not cause hemodynamic instability, even in patients with cirrhosis. Massive acute hemoperitoneum from a ruptured intraperitoneal varix is an unusual complication of portal hypertension requiring prompt surgical treatment. Acute hemoperitoneum develops in 5-15% of patients with hepatocellular carcinoma requiring transcatheter arterial embolization. Metastatic liver tumors cause bloody ascites infrequently; however, this is a common complication of ovarian carcinoma. Hemoperitoneum is a severe complication in patients with ascites. When it develops spontaneously, it is usually related to the same disease process that caused the formation of ascites. Massive bloody ascites develops acutely after the rupture of intra-abdominal varices or hepatocellular carcinoma and requires aggressive interventional management. Based on a review of published data and on personal experience with patients suffering from end-stage liver disease, I propose an algorithm for the evaluation and treatment of patients with cirrhosis and hemoperitoneum.
              Article 0 comments Cited 22 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Yueh-Lin Wu: DAL93@tpech.gov.tw
                Yi-Sheng Lin:
                ORCID: http://orcid.org/0000-0001-9415-4243
                886-2-27861288 , yslin3@gmail.com
                Thomas Yu-Ren Hsueh: DAJ53@tpech.gov.tw
                Wen-Ching Lo: DAI06@tpech.gov.tw
                Kuo-Chou Peng: DAL62@tpech.gov.tw
                Mu-Jung Kao: DAJ46@tpech.gov.tw
                Journal
                Journal ID (nlm-ta): BMC Nephrol
                Journal ID (iso-abbrev): BMC Nephrol
                Title: BMC Nephrology
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2369
                Publication date (Electronic): 4 July 2018
                Publication date PMC-release: 4 July 2018
                Publication date Collection: 2018
                Volume: 19
                Electronic Location Identifier: 165
                Affiliations
                [1 ]Department of Nephrology, Taipei City Hospital, Zhongxiao Branch, No. 87, Tongde Road, Nangang District, Taipei, 115 Taiwan
                [2 ]Division of Urology, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan
                [3 ]Division of Gastroenterology, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
                [4 ]Division of Medical Imaging, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
                [5 ]Division of Rehabilitation, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
                Author information
                http://orcid.org/0000-0001-9415-4243
                Article
                Publisher ID: 974
                DOI: 10.1186/s12882-018-0974-6
                PMC ID: 6033235
                PubMed ID: 29973169
                SO-VID: 6840659f-cff8-415a-a188-33da1097ccf0
                Copyright © © The Author(s). 2018
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 24 January 2018
                Date accepted : 27 June 2018
                Categories
                Subject: Case Report
                Custom metadata
                issue-copyright-statement © The Author(s) 2018

                ScienceOpen disciplines: Nephrology
                Keywords: gallbladder perforation,peritoneal dialysis,green dialysate,cholecystectomy,peritonitis
                Data availability:
                ScienceOpen disciplines: Nephrology
                Keywords: gallbladder perforation, peritoneal dialysis, green dialysate, cholecystectomy, peritonitis

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