Evolving changes in the pathogenesis and treatment of the perforated gallbladder. A combined hospital study.

Perforation of the gallbladder occurred in 35 patients in this 6 year review, with a 2.3:1 male predominance in contrast with a female dominance in nonperforated acute cholecystitis. Thirty-three percent of patients with gallstones had a history of symptomatic cholelithiasis which emphasizes that if elective cholecystectomy had been performed, this complication could have been avoided. Further, a large number of cases (40 percent) were found to be of the acalculous variety which suggests a possible changing trend in the pathogenesis of perforated gallbladder. Cholecystectomy with intraoperative cholangiography and adequate drainage appears to be the procedure of choice, and aggressive operative intervention without delay is thought to contribute to the relatively low mortality of 8.6 percent in this series.