The gallbladder is a small, pear-shaped organ located beneath the liver in the upper right abdomen. Its primary function is to store and concentrate bile, a digestive fluid produced by the liver that helps break down fats. A gallbladder rupture occurs when the organ’s wall develops a hole or tear, allowing its contents—bile and often bacteria—to leak directly into the sterile abdominal cavity. This event is a serious medical emergency requiring immediate intervention to prevent life-threatening complications.
Underlying Causes Leading to Rupture
The most frequent cause of gallbladder rupture is severe acute cholecystitis, which is sudden inflammation of the gallbladder. This inflammation is typically caused by gallstones lodged in the cystic duct, which connects the gallbladder to the main biliary system. The obstruction prevents bile from draining, leading to a rapid buildup of pressure and distension within the gallbladder walls.
The increased internal pressure compromises the organ’s blood supply, resulting in localized tissue death, known as ischemia and necrosis. As the tissue dies, the structural integrity of the gallbladder wall weakens, making it vulnerable to tearing. This perforation allows irritating bile and infectious bacteria that have colonized the stagnant environment to spill out into the abdomen.
Recognizing the Immediate Symptoms
A ruptured gallbladder presents with a sudden, sharp intensification of pain in the upper right abdomen. This pain often spreads and becomes generalized across the entire abdominal area, indicating that the irritating contents have spilled out.
Accompanying the intense pain are signs of severe infection, including high fever and chills. Nausea and vomiting are common, and in severe cases, the patient may exhibit signs of shock, such as a rapid heart rate and low blood pressure. The abdomen may also become rigid and tender to the touch, signaling widespread inflammation of the abdominal lining.
Internal Dangers: Peritonitis and Sepsis
The internal consequences of a rupture are severe because the normally sterile abdominal cavity is suddenly exposed to infectious material. The immediate danger is peritonitis, which is the inflammation and infection of the peritoneum, the membrane lining the abdominal wall and organs. Bile itself is a chemical irritant, causing a sterile, inflammatory reaction upon contact with the peritoneum.
The stagnant bile within the inflamed gallbladder is frequently contaminated with bacteria, such as Escherichia coli and Klebsiella. When the gallbladder ruptures, this infected bile spills out, transforming the chemical irritation into widespread, infectious peritonitis. This secondary peritonitis can remain localized, forming a pus-filled pocket called an abscess, or spread rapidly throughout the abdominal cavity.
If the infection is not quickly controlled, the body’s inflammatory response can become overwhelming, leading to a life-threatening systemic condition called sepsis. Progression to septic shock, characterized by dangerously low blood pressure and organ failure, is a major risk of an untreated ruptured gallbladder.
Emergency Medical Interventions
A ruptured gallbladder requires immediate surgical intervention. The first priority is patient stabilization, which involves administering intravenous fluids to manage shock and starting broad-spectrum antibiotic therapy. These antibiotics are used to combat the bacterial contamination that has caused infectious peritonitis.
The definitive treatment is an emergency cholecystectomy, the surgical removal of the diseased gallbladder. This procedure eliminates the source of the infection and prevents further leakage of contaminated bile. The surgery typically involves a thorough washing, or lavage, of the entire abdominal cavity to remove any spilled bile, pus, and debris. Surgeons may perform the removal using a minimally invasive laparoscopic approach or an open surgery technique, depending on the severity of the inflammation, the extent of the contamination, and the patient’s overall stability.