POSTOPERATIVE GANGRENOUS PERITONITIS AFTER LAPAROSCOPIC CHOLECYSTECTOMY - A NEW COMPLICATION FOR A NEW TECHNIQUE

We report a case of anaerobic peritonitis with bowel emphysema, but no hollow organ perforations, following gallbladder removal for acute ac alculous cholecystitis using a laparoscopic procedure in a diabetic pa tient. Management consisted of profuse peritoneal irrigation and zippe r laparostomy. After a long postoperative period, the patient recovere d without sequelae. The patient suffered typical acute cholecystitis w ith empyema and a diabetic status; anaerobial flora is frequent in the se cases. The patient was operated on by means of a closed technique w ithout contact with either air or oxygen. Moreover, CO2 injection into the peritoneal cavity with this technique, along with gallbladder rup ture, created an ideal medium for anaerobial growth. We suggest that a calculous cholecystitis in diabetic patients could represent a contrai ndication for laparoscopic cholecystectomy; alternatively, open cholec ystectomy should at least be considered when gallbladder rupture occur s during laparoscopy.