Slovenská chirurgia 4/2019
Perforácia žlčníka
MUDr. Jozef Brezina, prof. MUDr. Jozef Radoňak, CSc., MPH
Perforácia žlčníka je závažnou komplikáciou akútnej cholecystitídy. Vyskytuje sa asi u 2 - 11 % prípadov cholecystitídy. Prístup k liečbe sa od jej klasifikácie Niemeierom v roku 1934 značne zmenil. Niemeier rozdelil perforáciu žlčníka na 3 typy: I. typ - akútna perforácia do peritonálnej dutiny, II. typ - subakútna perforácia s tvorbou abscesu a III. typ - chronická perforácia s tvorbou fistuly medzi žlčníkom a iným orgánom s alebo bez rozvoja biliárneho ileu. Perforácia žlčníka predstavuje výzvu v diagnostike, liečbe a je spojená s vysokou morbiditou a mortalitou. Od rozdelenia perforácie na spomínané tri typy však možnosti diagnostiky, ale aj terapeutické možnosti prešli značným vývojom, čo viedlo k zvýšeniu úspešnosti liečby a následnému poklesu mortality.
Kľúčové slová: cholecystitída, perforácia žlčníka, biliárny ileus, Niemeierova klasifikácia
Gallbladder perforation
Gallbladder perforation is a serious complication of acute cholecystitis. It occurs in about 2 - 11% of cholecystitis cases. The approach to treatment and management has changed considerably since its classification by Niemeier in 1934. Niemeier divided gallbladder perforations into three types: type I - acute perforation into free peritoneal cavity, type II - subacute perforation with abscess formation and type III - chronic perforation with fistula formation between galbladder and other organ with or without development of biliary ileus. Galbladder perforation presents a challenge in diagnosis, treatment and is associated with high morbidity and mortality. However, since the classification into three types mentioned above, the possibilities of diagnostics as well as therapeutic options have evolved considerably, leading to increased treatment success rate and a consequent decline in mortality.
Keywords: cholecystitis, gallbladder perforation, biliary ileus, Niemeier classification
