Gallbladder perforation presenting with hemorrhagic shock: Two case reports and an approach to management
Bibliographic record
Abstract
Gallbladder perforation is an uncommon surgical condition usually secondary to severe acute cholecystitis. In this report we present a comparison of management for two comorbid patients with gallbladder perforation who presented atypically with hemorrhagic shock, symptomatic large volume hemoperitoneum, and did not have evidence of acute cholecystitis. One patient had a clearly identified gallbladder wall perforation on initial imaging with hemodynamic instability and underwent urgent laparotomy and cholecystectomy. The other patient did not have a clearly identified source for the hemoperitoneum and was later found to have a biliary leak through a HIDA scan. He was a poor surgical candidate due to extensive co-morbidities and was stabilized with resuscitative measures. He was managed conservatively for several days before he clinically deteriorated and passed away. Both patients had different outcomes based on their underlying co-morbidities, presentations and treatment plans.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.014 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.006 | 0.003 |
| Science and technology studies | 0.004 | 0.003 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.003 | 0.005 |
| Research integrity | 0.008 | 0.005 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".