An unusual presentation of gall bladder perforation with hepatic subcapsular collection

Abstract

A 60 year old male presented with Gall Bladder perforation in a case of calculous cholecystitis with perforation at the tip of the fundus. The perforation lead to collection of bile under the liver capsule. This case is unusual as clinically suggestive of liver abscess and the perforation didn't lead to biliary peritonitis. Gall Bladder perforation is life threatening event associated with increased morbidity and mortality. Cholecystectomy with peritoneal lavage is the treatment of choice.

Keywords: Complications of Cholelithiasis; Gall bladder perforation; Hepatic sub-capsular collection.

Fig. 1

a Ultrasound showing hepatic subcapsular collection. b Ultrasound showing hepatic subcapsular collection

Fig. 2

Pigtail catheter in right hypochondrium

Fig. 3

CT scan showing tip of pigtail catheter in subphrenic space and peri-hepatic collection

Fig. 4

CT scan showing peri-hepatic collection

Fig. 5

Liver surface laden with bile

Fig. 6

Perforation of gall bladder fundus

Fig. 7

Multiple calculi from gall bladder

Fig. 8

Gall bladder with multiple calculi