Among the atypical manifestations of dengue fever, comprising 15.8% of all cases, acalculous cholecystitis forms a small subset. Acalculous cholecystitis is managed conservatively in majority of cases and a chance of gall bladder perforation is low (2-18%). Management of gall bladder perforation in the scenario of Dengue is sometimes complicated by presence of thrombocytopenia and its complications thereof. Mortality associated with gall bladder perforation is relatively high. Gallbladder usually perforates at the fundus and is to be dealt with surgically if it doesn’t localize. Laparoscopic management of gall bladder perforation is feasible as calot’s is relatively virgin (as there is no calculous disease). Thorough peritoneal toileting is possible and a chance of intra-abdominal abscess in post-operative period is a mere speculation. Laparoscopic management results in early recovery and fewer wound complications and lesser hospital stay.
Laparoscopic management of massive intraperitoneal haemorrhage caused by an acute gallbladder perforation
