Perforations of the gallbladder and cholecystobiliary fistulae: a review of management and a new classification.

Experiences with seven cases of gallbladder perforation managed in Kingston, Jamaica, at the District of Columbia General Hospital, and other Howard University affiliated hospitals are presented. The results of a review of 197 consecutive biliary operations at DC General Hospital for occurrence of this entity are presented.Gallbladder perforation is a complication of cholecystitis in 1 to 4 percent of cases. Niemeier(1) classified this complication in three types in 1934, and currently these are described as type 1-free perforation, type 2-perforation with abscess, and type 3-chronic perforation with cholecysto-enteric fistula.The gallbladder may, in extremely unusual occurrences, perforate into the biliary tree itself with significant operative implications, and therefore Niemeier's classification can be modified to include cholecystobiliary fistuale formation as type 4. Seven case reports manifesting all four types of perforation are presented, representing the spectrum of current treatment and diagnostic options.