Case Study: A 60-Year-Old Man Develops Gallbladder Perforation After Delaying Surgery for Gallstones and Acute Cholecystitis

A 60-year-old male patient arrived at the hospital with severe abdominal pain and fever. One week prior, he had been diagnosed with gallstones and acute cholecystitis. However, due to family concerns, he avoided surgical treatment and opted for conservative management instead. Unfortunately, his condition worsened over time, prompting him to seek care at our facility.

After a thorough physical examination and abdominal CT scan, he was diagnosed with gallbladder perforation accompanied by multiple intra-abdominal abscesses. Blood tests confirmed a severe infection. The patient was immediately admitted to the intensive care unit for close monitoring and treatment.

Understanding the Severity of Gallbladder Perforation

Gallbladder perforation is a life-threatening complication of untreated acute cholecystitis. In this case, the delay in surgery allowed the infection to progress, ultimately resulting in rupture and widespread abdominal infection. Immediate intervention was crucial to prevent further deterioration.

Effective Treatment Approach

Given the patient's unstable condition—marked by tachycardia and hypotension—indicative of septic shock, the priority was to control the infection. Under ultrasound guidance, a gallbladder and abdominal abscess drainage procedure was performed, successfully removing approximately 2000 mL of pus. Intravenous antibiotics (cefoperazone sodium) and fluid resuscitation (with hydroxyethyl starch and saline) were administered to combat infection and stabilize his vital signs.

Positive Recovery Outcomes

Within two days, the infection markers began to decline, and the patient's overall condition improved significantly. By the third day post-procedure, his fever subsided, and abdominal discomfort eased. He gradually resumed oral intake and gained strength. After one month of inpatient care, the infection was fully controlled, and he was discharged without complications.

Post-Discharge Care and Recommendations

Following discharge, maintaining proper drainage from the gallbladder tube is essential. Regular follow-ups are necessary to monitor for any signs of residual infection. Patients should seek immediate medical attention if symptoms such as fever reappear. Dietary recommendations include consuming light, nutritious, and easily digestible meals while avoiding spicy or cold foods. Emotional well-being also plays a role in long-term recovery.

Importance of Timely Medical Intervention

This case highlights the dangers of delaying surgical treatment for gallstones and acute cholecystitis. Early cholecystectomy is often the best course of action to prevent complications like abscess formation, gangrene, or perforation. Once the gallbladder ruptures, the risk of life-threatening sepsis increases dramatically. Prompt medical care can make a critical difference in patient outcomes and reduce the complexity of treatment.