%0 Journal Article
%T Intrahepatic type II gall bladder perforation by a gall stone in a CAPD patient
%A T G£¿bel
%A R Kubitz
%A D Blondin
%A D H£¿ussinger
%J European Journal of Medical Research
%D 2011
%I BioMed Central
%R 10.1186/2047-783x-16-5-213
%X We report a case of a 30-year old female patient with end-stage kidney disease treated by continuous ambulatory peritoneal dialysis (CAPD) who was admitted to the emergency room with fever and mild abdominal pain. A type II gall bladder perforation by a solitary gall stone with development of a liver abscess was detected by abdominal ultrasound.Gall bladder perforations are rare but have to be considered in patients with abdominal pain and fever. Abdominal ultrasound is a reliable tool to establish diagnosis.A perforation of the gall bladder represents a life-threatening complication of cholecystitis, which occurred in historical study cohorts with an incidence of up to 10-15% [1-3] during acute cholecystitis. The establishment of early cholecystectomy and improvement of antibiotic therapy regimen have reduced the risk of gall bladder perforation in acute cholecystitis to 0.8-3.2% today [4-6].Gall bladder perforation was classified by Niemeier into three categories [7]. Type I perforation presents as an acute disease with perforation into the free abdominal cavity, whereas type II perforation is characterized as a subacute stage with development of a pericholecystic abscess. Type III perforation arises in chronic cholecystitis with development of bilioenteric fistulae. Especially in chronic cholecystitis diagnosis of a gall bladder perforation may be delayed, when acute symptoms including peritonism are missing [8]. In these cases abdominal imaging by ultrasound or computed tomography is a useful tool.We report on an oligosymptomatic gall bladder perforation into the liver due to cholecystolithiasis in a patient with peritoneal dialysis.A 30-year old female patient was admitted to the emergency unit with fever (40¡ăC) for two days, mild pain in the right upper abdomen and deteriorated health condition. The patient was treated by dialysis since nine years because of a hemolytic-uremic syndrome, for the last seven years dialysis was done via continuous ambulatory perit
%K gall bladder perforation
%K liver abscess
%K CAPD
%U http://www.eurjmedres.com/content/16/5/213