Author/Editor		Gajzer, Borut; Koželj, Miran; Andromako, Nikica
Title		Spontano predrtje žolčnika: prikaz primera
Translated title		Spontaneous gallbladder perforation: a case report
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 39, št. 4
Publication year		2000
Volume		str. 429-34
Language		slo
Abstract		Gallbladder perforation can appear as an acute perforation followed by biliary peritonitis, as subacute perforation with the formation of a pericholecystic abscess, or as a chronic condition leading to cholecysto-enteric fistula formation. It is mainly associated with gallbladder diseases caused by gallstones, although gallstones are not necessarily an essential feature of perforation. Male sex, diabetes mellitus, atherosclerosis, immune system suppression, carcinoma, parentexal nutrition and severe hepatic diseases are involved as risk factors for , gallbladder perforation. Early suspicion and prompt surgical intervention are vital in the treatment of patients with gallbladder perforation due to the high mortality rate of this condition. Ultrasonography of the abdomen is the most frequently used diagnostic tool, but cholescintigraphy is the most accurate one in demonstrating a perforated gallbladder. A preoperative diagnosis of a perforation is rare. This report concerns a younger patient with an acute spontaneous gallbladder perforation and diffuse biliary peritonitis. A diagnosis of a perforation was not made until during the operation. No gallstones or other risk factors for gallbladder perforation were found, but the pathohistological examination revealed cholesterolosis and a mild chronic inflammation of the gallbladder.
Summary		Predrtje žolčnika je Iahko akutno s posledičnim biliarnim vnetjem potrebušnice, subakutno z nastankom ognojka (abscesa) ali kronično z nastankom fistuil med žolčnikom in črevesjem. Najpogosteje je povezano z boleznimi žolčnika, ki so posledica žolčnih kamnov, vendar sami žolčni kamni ne pogojujejo nastanka predrtja. Dejavniki tveganja za predrtje so moški spol, sladkorna bolezen, ateroskleroza, zavrt imunski sistem, raki, parenteralno hranjenje in huda obolenja jeter. Zaradi visoke smrtnosti pri predrtju žolčnika sta pri obravnavi bolnikov pomembna zgodnji sum na predrtje in hitro kirurško ukrepanje. Od preiskav se največ uporablja ultrazvočni pregled trebuha, najbolj natančno pa predrtje pokaže scintigrafija žolčnika. Pred operacijo postavljena diagnoza predrtja žolčnika je redka. Predstavljen je primer mlajšega bolnika z akutnim spontanim predrtjem žolčnika in razširjenim biliarnim vnetjem potrebušnice. Diagnozo predrtja smo postavili šele med operacijo. Pri bolniku nismo našli žolčnih kamnov ali drugih. dejavnikov tveganja za predrtje žolčnika, patohistološki pregled pa je pokazal holesterolozo in blago kronično vnetje žolčnika.
Descriptors		GALLBLADDER DISEASES RUPTURE, SPONTANEOUS CHOLELITHIASIS BILIARY FISTULA ADULT