J Korean Surg Soc.  2010 Sep;79(3):228-233.

Iatrogenic Gallbladder Perforation during Gastric Endoscopic Mucosal Resection

• Kee SK
• Kim JO
• Kwon OK
• Nam SY

Abstract

With the exception of accidental perforation during a laparoscopic Cholecystectomy, An Iatrogenic Gallbladder Perforation Is Quite Rare. Several Cases Have Been Reported As A Complication Of Interventional Or Endoscopic Procedures. Although A Case Of Gallbladder And Stomach Perforation During Gastric Endoscopic Mucosal Resection (Emr) Has Been Reported, We Encountered A Case Of Gallbladder Perforation During Gastric Emr Without Evidence Of A Perforation Of The Stomach, Which Has Not Been Reported In The Literature.

Keyword

Gallbladder perforation; Iatrogenic; Gastric EMR

MeSH Terms

Cholecystectomy, Laparoscopic
Gallbladder
Stomach

Figure

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  Fig. 1 (A) The margin around the polyp of the antrum was marked with a needle knife using a coagulation current, and epinephrine-mixed saline was injected beneath the mucosa to elevate the lesion. The lesion was retracted with grasping forceps and excised by closing the snare and an electrosurgical current. Bleeding was noted at the polypectomy site and controlled without difficulty using 3 hemoclips. (B) The polyp of the distal body was excised using the same method without bleeding.

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  Fig. 2 After gastric endoscopic mucosal resection, simple abdominal x-ray revealed a distended stomach with air and no intraabdominal free air.

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  Fig. 3 (A) Non-enhanced abdominal computed tomography scan showed an air bubble abutting the wall of the gallbladder (arrowhead) and a small quantity of fluid in the perihepatic space (arrow). (B) The follow-up contrast-enhanced CT scan showed increased fluid collection in the perihepatic space (arrow) and an air bubble with no changes compared to the previous non-enhanced CT scan (arrowhead).

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  Fig. 4 Intraoperative findings. (A) Bile leakage was observed through a small perforation of the body of the gallbladder (arrow). (B) An esophagogastroduodenoscopic examination was performed and no perforation was observed.

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  Fig. 5 Needle knife used to mark the lesion for an endoscopic polypectomy.

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