Gallbladder perforation: A rare case report

Abstract

Introduction: Gallbladder perforation (GBP) is a rare but severe, often fatal, disease due to its delayed pathology, demanding urgent surgical intervention. GBP can result from acute cholecystitis in 6-12 % of cases. It manifests in a variety of presentations. The diagnosis is frequently postponed or missed.

Case presentation: A 68-year-old woman came to the emergency department with the chief complaint of abdominal pain for 1 week. The pain began in the epigastric region and right upper abdominal quadrant, then extended to the whole abdomen. Abdominal bowel sounds were decreased, with muscular defense and tenderness throughout the abdomen. On rectal touch examination, the sphincter was loose. Laboratory tests found leukocytosis and hyperglycemia. An abdominal ultrasound examination showed cholelithiasis, sludge, and little echo fluid in the lower right abdomen.

Clinical discussion: The patient was diagnosed with generalized peritonitis and cholelithiasis with sepsis (qSOFA score 2; SOFA score 2). An emergency exploratory laparotomy was performed. We found gallbladder (GB) dilatation with fibrin surrounding the GB wall and a perforation in the border of the GB neck and cystic duct of around 10 mm in diameter. We performed cholecystectomy in the distal region of perforation. Antibiotics and analgesics were used. The patient was discharged on postoperative day 5. After 4 weeks, she was followed up and doing well with no complaints.

Conclusion: Early diagnosis and treatment are essential for GBP to prevent morbidity and mortality. Initial management is required; in patients with acute abdominal pain, the surgeon should suspect the cause may be GBP.

Keywords: Abdominal pain; Case report; Cholecystitis; Gallbladder perforation.

Fig. 1

Intraoperative imaging showing: (A) pus and fibrin (arrow) in the subserosa of the gallbladder (B) perforation (arrow) of around 10 mm in the gallbladder neck, (C) gallbladder with gallstones and sludge.