How Long Can you Live with a Ruptured Gallbladder? 7 facts.

Gallbladder rupture often occurs due to complicated acute cholecystitis.

Rarely, it may occur due to other causes such as gallbladder infection with ascariasis, bacteria, and traumatic rupture due to blunt abdominal trauma.

Patients who survive the first critical days or weeks of gallbladder perforation often live for years. On the other hand, the majority of mortality cases are within the first ten days after the diagnosis of gallbladder perforation.

Today, you will learn about the possible scenarios of gallbladder rupture, the survival rates, diagnosis, and best treatments.

1. Who is at higher risk of a ruptured gallbladder?

The following are predictive risk factors for complications such as gallbladder rupture and gangrene (reference):

• Delayed diagnosis of acute cholecystitis.
• Acute cholecystitis in older ages (often above 45 years old).
• Diabetes mellitus.
• Male gender.
• Temperature >38 degrees celsius.
• White blood cell count greater than 18,000/CC.

2. Can you live with a ruptured gallbladder?

Emergency cholecystectomy is the gold standard for the treatment of a ruptured gallbladder. Unfortunately, even in people with older ages and concomitant diseases, failure or delay in performing cholecystectomy is associated with higher mortality rates.

The majority of people with a ruptured gallbladder will live after the operation. However, not performing emergency cholecystectomy will increase mortality among people with a ruptured gallbladder.

Gallbladder rupture is often preceded by the death of its wall (gallbladder gangrene). The mortality rate of complicated acute cholecystitis (as with gangrene and perforation) may reach 22% (reference).

Without urgent surgery (cholecystectomy), the likelihood of dying from a ruptured gallbladder is even more.

Some people can survive with a ruptured gallbladder, but the odds of death are very high without emergency medical treatment or surgery.

A ruptured gallbladder leads to bile leakage and bacteria, leading to local access around the gallbladder (pericholecystic abscess) or the spread of the infection through the abdomen (diffuse peritonitis).

Eventually, the ruptured gallbladder may predispose to sepsis, an abnormal and violent response from your body’s immune system.

The sepsis responses may lead to life-threatening multi-organ dysfunction and/or low blood pressure (septic shock). All these consequence increases the risk of dying from a ruptured gallbladder if left untreated or undertreated.

3. How long can you live with a ruptured gallbladder?

Once a gallbladder rupture is diagnosed, an emergency surgery (cholecystectomy) must be carried out urgently.

A delay in the diagnosis and/or treatment of a ruptured gallbladder can result in rapid deterioration and death.

Most people will survive this complication with appropriate treatment (emergency cholecystectomy and appropriate post-operative antibiotics).

However, 12% to 42% of patients with perforated gallbladder may die from such complications.

Patients who survive the first critical days or weeks of gallbladder perforation often live for years. On the other hand, the majority of mortality occurs within the first ten days after the diagnosis of gallbladder perforation.

4. What is the predictor of death from a ruptured gallbladder?

Predictors of mortality include (reference):

• The longer delay time before hospital admission.
• Low white blood cell count (indicating poor immune system response).
• Higher AST, ALT, Alkaline phosphatase, and total bilirubin levels.
• Presence of diabetes mellitus.
• Presence of fluid collection around the gallbladder (in abdominal imaging such as abdominal ultrasound).
• Failure of laparoscopic surgery (with subsequent conversion to open surgery).

5. What are the symptoms of a ruptured gallbladder?

Gallbladder rupture is difficult to diagnose based on clinical symptoms and signs. The symptoms of gallbladder rupture are not specific and nearly identical to acute cholecystitis.

The two main differences are:

• Disappearances of murphy’s sign (it is a sign checked by your doctor, not a symptom; Explained below).
• Higher prevalence of sepsis symptoms.

The main symptoms and signs of a perforated gallbladder include:

A. Symptoms of acute cholecystitis.

• Acute onset of severe biliary colic (severe dull aching pain in the right upper quadrant of the abdomen).
• The pain often radiates to the epigastric area (upper central abdomen), the right-back, and the right shoulder).
• The attack of pain is often prolonged (more than 6 hours). It may resolve partially, but it comes back again.
• Associated symptoms include severe anorexia, tender abdomen, nausea, vomiting, and fever.

B. Symptoms of sepsis.

Sepsis is one of the most serious and life-threatening consequences of gallbladder perforation.

Sepsis symptoms are often not very specific, and it can occur with other complications of gallstones such as obstructive jaundice and pancreatitis.

Symptoms of sepsis include:

• ever.
• Toxic (pale) look.
• Extreme fatigue and tiredness.
• Shortness of breath.
• Fast heartbeats.
• Dizziness, lightheadedness.
• Muscle aches.
• Clammy or sweaty skin.
• Confusion, coma, and low blood pressure (septic shock) are severe cases.

C. Disappearance of murphy’s sign.

Murphy’s sign is one of the common clinical signs that doctors use to diagnose acute cholecystitis.

Patients with cholecystitis (unperforated) often hold their inspiration when the doctor puts his hands on the gallbladder area and ask them to take a deep breath.

The holding of breath is a reflex to the severe pain resulting from the compression of the unperforated gallbladder between the diaphragm and the doctor’s hands during inspiration.

In patients with a perforated gallbladder, the murphy’s sign may disappear. However, doctors cannot rely on such signs to diagnose gallbladder perforation or gangrene.

6. How is a ruptured gallbladder diagnosed?

Even with advanced imaging techniques, the diagnosis of gallbladder perforation is uncommon before cholecystectomy and is often diagnosed during gallbladder removal surgery (reference).

The diagnosis of gallbladder rupture can be made by imaging studies such as abdominal ultrasound and abdominal CT.

The following findings in abdominal imaging may indicate gallbladder rupture (reference):

• Fluid collection around the gallbladder.
• Disruption of a part of the gallbladder wall.
• Part of the gallbladder wall appears inside the abscess around the gallbladder (pericholecystic abscess).

It is very difficult to detect gallbladder rupture with an abdominal ultrasound. And the abdominal CT is more accurate in diagnosing gallbladder rupture.

The sensitivity of abdominal CTin detection of gallbladder rupture is about 88% (reference).

7. Types of gallbladder perforation (and which is more dangerous).

The most widely used classification of gallbladder perforation is the Niemeier classification. Niemeier classified gallbladder rupture into three main types (reference).

A. Type I (acute): commonest, 68%.

In type I gallbladder rupture, the perforation is free, and the bile spreads through the abdominal cavity causing diffuse peritonitis.

B. Type II (subacute): 16%

The perforation causes localized (not diffuse) peritonitis around the gallbladder and a gallbladder abscess.

C. Type III (chronic): 16%

Type III gallbladder perforation is also called a cholecysto-enteric fistula. In this type, a tract (fistula) forms between the ruptured gallbladder and the nearby gastrointestinal tract (commonly the duodenum or the colon).

According to one review study, mortality doesn’t vary significantly between different types of gallbladder perforation.

So, no specific type of perforation is more dangerous than the others. However, mortality appears to be more affected by age and co-existing diseases such as diabetes and atherosclerosis.