Digestion

Gangrenous Gallbladder – Treatment

The gallbladder is a small pear shaped sac placed under the liver. The liver secretes bile which is a yellowish green liquid that helps in the digestion of fats. The gallbladder is used to store the bile and release it to the small intestine as and when necessary to help in the breaking down of food.

Gallstones are concentrated masses of fat and cholesterol droplets available in excess in the bile. They are produced when bile assumes a thicker consistency in the gallbladder. The gallstones can travel down and get lodged into the bile duct causing obstructive infection. The bile duct is the connecting tube between the gallbladder and the duodenum (first part of the small intestine). Statistics reveal that of all types of gallbladder diseases, about 10% of them are caused by gallstones blocking the pathway of bile and causing acute cholecystitis or gallbladder infection.

Gangrenous gallbladder

is essentially a complication of acute cholecystitis. It can be seen in about 30% of patients with acute gallbladder infection. When the bile cannot pass through into the intestine, the reflux and the accumulation of it causes the walls of the gallbladder to expand. The stress coupled with the corrosive impact of the denser bile starts damaging the tissue in the area. The bacteria and other microbes in the gut lends a hand in the organ getting infected. The term “gangrenous” refers to the destruction, death or necrosis of tissue. In this case, the ultimate result is a gangrene in the tissues of the gallbladder wall.

  • Abdominal pain

    Intense pain in the upper right quadrant of the abdomen and around the belly button is the first symptom. The pain builds up over time becoming less focal and spreading all over the abdomen. It intensifies with inhalation. If the infected tissue in the gallbladder wall gives away causing a perforation, the pain may improve owing to the release of the pressure from the built up bile. However, as the contents of the gallbladder get spilled all over the other abdominal organs, infection and the pain, both returns soon.

  • High Fever

    High fever would be present indicating an infection.

  • Tachycardia or fast heartbeat

    Racing heartbeat is perceptible to the patient. This may be present with bouts of intense sweating.

  • Drop in blood pressure

    This too is indicative of the gallbladder being infected. Dizziness and confusion often follows.

  • Nausea and vomiting

    This is a common symptom in any gallbladder disease.

  • Distended abdomen

    The infection brings about an inflammation of the overall abdomen. This condition is known as peritonitis. The bloating or distension is also brought about by the fact that the activity of the intestines is slowed down affecting the transit time of food through the digestive system. The abdominal wall becomes taut and rigid.

  • Fatigue

    Severe fatigue and loss of consciousness due to the pain involved has also been reported.

Diagnostic Tests

  • A normal physical check can hardly help detect the gangrene in the gallbladder. The distended abdomen and faster heart beat can at best suggest an abdominal infection.
  • Blood tests revealing an increase in the count of the white blood cells (WBC) again confirms the infection.
  • An abdominal ultrasound is required to pinpoint the problem in the gallbladder.
  • A Computed Topography Scan is mostly used to detect the condition.

Treatment of Gangrenous Gallbladder

  • Cholecystectomy

    Since the gangrene involves a patch of dead and infected tissue, it becomes imperative that the tissue be removed through surgery. The bile can also be channeled to the intestine directly in the absence of the gallbladder. Hence, gallbladder removal does not affect the quality of life and is the most preferred treatment option for physicians. This surgery can be done through an open procedure or it can be done through a minimally invasive laparoscopic procedure.

  • Antibiotics

    These are used to arrest the accompanying infection. The drug Indomethacin is used to control the inflammation and pain associated with the infection.

  • Sphincterotomy

    It is done by inserting a tube with a camera like that of the endoscope to extract the gallstone blocking the pathway of the bile.

  • Lithotripsy

    It is used to blast the gallstone into granular pieces by using high frequency sound waves.

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