Ultrasonography and gallbladder perforation in acute cholecystitis.

A group of 24 patients with perforated gallbladder operated upon between 1980 and 1987 was compared with a group of 21 patients operated upon in 1982 due to uncomplicated acute cholecystitis in order to find out whether it was possible to use some specific sonographic signs to find the patients at risk of perforation. Free fluid and fluid collections close to the gallbladder fossa were found in 9 patients. The patients with perforated gallbladders tended to have a slightly thicker gallbladder wall--7 mm (range 3-20 mm)--when compared with the uncomplicated cases of acute cholecystitis--5.3 mm (range 2-13 mm). Localized fluid collection in the wall of a gallbladder was seen in a patient just prior to the perforation. It was, however, not possible to find a common sign characteristic for imminent perforation. The study showed, however, that the combination of early diagnosis with ultrasound together with aggressive surgery reduced the mortality at gallbladder perforation to none in the last 9-year-period compared with 10 per cent in the previous 9-year-period.