Green dialysate and gallbladder perforation in a peritoneal dialysis patients: a case report and literature review

Abstract

Background: Gallbladder perforation is a rare but lethal condition and its diagnosis is usually difficult and delayed. Frequently, gallbladder rupture is associated with cholecystitis, but spontaneous perforation was ever described. However, spontaneous rupture of gallbladder has never been reported in patients underwent peritoneal dialysis.

Case presentation: We report a 62-year-old man who presented with abdominal pain for 2 days to clinic. Peritoneal dialysis-related peritonitis was diagnosed initially. It was followed by spontaneous gallbladder perforation with greenish dialysate. The patient was managed successfully by antibiotic treatment and primary closure of gallbladder perforation with external drainage. He recovered from this critical condition and stayed on dialysis.

Conclusions: Early diagnosis and timely surgical intervention yields a good prognosis in PD patients with gallbladder perforation. Surgical intervention and antibiotic treatment are the mainstay of treatment. Both of them should take place promptly.

Keywords: Cholecystectomy; Gallbladder perforation; Green dialysate; Peritoneal dialysis; Peritonitis.

Fig. 1

Peritoneal dialysis fluid. The color of peritoneal dialysis fluid was from yellow at initial presentation (a) and became green after fasting for 24 h (b)

Fig. 2

Abdominal ultrasonography revealed distended gall bladder with sludge within it without wall thickening (white arrow); Abdominal computed tomography scan revealed dilated bowel with air-fluid level, much fluid around spleen and a distended gallbladder with modest thickening of the wall (black arrow)