Spontaneous gallbladder perforation in a man with gallstone disease without known anamnesis of cholecystitis: Case report.

INTRODUCTION: Spontaneous gallbladder perforation is a rare complication of gallstone disease. It causes acute peritonitis with potentially fatal outcome. CASE PRESENTATION: We present a case of spontaneous gallbladder perforation with challenging diagnosis. DISCUSSION: The diagnosis of gallbladder perforation should be considered in elderly patients presenting to the surgical emergency department with symptoms and signs of peritonitis even in the absence of pre-existing gallbladder disease. Spontaneous gallbladder perforation is a rare and potentially fatal diagnosis. In most reported cases, perforation occurred due to predisposing factors like acute cholecystitis, trauma or obstruction. In spite of rarity, spontaneous gallbladder perforation should be considered as differential diagnosis on examination of patients with sudden abdominal pain especially in cases of known cholecystolithiasis. Our patient had type 1 perforation according to Niemeier classification, the type associated with the highest mortality rate. The type of perforations has been reported as being difficult to recognize preoperatively, as with our patient with two inconclusive CT scans. This was due to the absence of classical symptoms of gallbladder perforation. CT is the modality of choice when gallbladder perforation is suspected. CONCLUSION: We believe the reason for the spontaneous gallbladder perforation in the presented case was the presence of cholecystolithiasis. We acknowledge the importance of considering this diagnosis also in patients without previous signs of cholecystitis.

Unusual Spontaneous Gallbladder Perforation in the Body Portion

Spontaneous gallbladder perforation is a rare complication of acute cholecystitis. The mechanism for the development of this complication is not clear, although a vascular anomaly and ischemia of the gallbladder appear to be important predisposing factors. It is rarely diagnosed preoperatively, and the delay in making the definitive diagnosis usually accounts for the increased incidences of morbidity and mortality associated with this complication. We experienced the unusual case of a 64-year-old male pa tient who presented with a 1-h history of generalized, especially right upper quadrant, abdominal pain. He had no history of traumatic, atherosclerotic, cardiovascular, metabolic disease. Abdominal ultrasono graphy demonstrated generalized free intraperitoneal fluid, especially in right lower quadrant, and was otherwise unremarkable. On palpation, his abdomen was rigid, and a provisional diagnosis of perforated peptic ulcer was made. The patient underwent a cholecystectomy. Gross examination of the gallbladder showed a pinhole perforation (1.2x1.0 mm2) in the body, but no gallstones. Microscopic examination of the wall revealed some neutrophile and lymphocyte infiltration and Widal test was negative. The patient had an uneventful recovery.