Aijaz Ahmed Memon.
Perforated Gall Bladder A Case Report.
J Surg Pak Jan ;6(3):37-.

Surgical complications of typhoid fever, like paralytic ileus or ileal perforation, are more common than those of Paratyphoid. Cholecystitis is also a frequent complication of this illness, but perforated gall bladder is rare. A case of perforated gall bladder due to typhoid is being reported here.

A 22-year old male presented with fever for 20 days and abdominal pain/ vomiting for 15 days. Fever was of continuous type that became high grade at night, not associated with rigors and relieved by taking medicines. He also developed gripping abdominal pain and vomiting on and off, five days after the start of fever. Medicines from local doctor did not relieve his symptoms completely. His abdominal pain gradually became worse and ultimately he was admitted to hospital. On examination he looked ill, wasted and dehydrated. There was tenderness more marked in the right upper abdomen with some degree of peritonism mostly on the right side of the abdomen. An initial diagnosis of small bowel perforation due to typhoid fever was made. Laboratory investigations showed a positive Widal test. Abdominal X-rays were not helpful towards the diagnosis. An ultrasound examination of abdomen showed fluid in the right subhepatic area, suggesting a diagnosis of perforated duodenal ulcer. After resuscitation exploratory laparotomy was performed and bile was found in the right upper abdomen, further the gall bladder was found ruptured at the fundus. Cholecystectomy and peritoneal lavage with saline was performed and abdomen closed after leaving a drain in the right subhepatic space. Postoperatively the patient recovered smoothly.

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