A case of idiopathic perforation of the gallbladder: Analysis of 29 cases

Abstract

A 70-year-old woman who noticed sudden abdominal pain in the evening presented the next morning to a nearby physician with symptoms of diffuse peritonitis. Abdominal ultrasonography (US) and computed tomography (CT) showed an enlarged gallbladder and fluid collection in the subphrenic space. She was referred to us with a diagnosis of diffuse peritonitis. Abdominal X-ray showed no free air. CT reexamination showed that the gallbladder was contracted and a small amount of fluid had collected around the gallbladder. Upper gastrointestinal endoscopy showed a duodenal ulcer, necessitating emergency surgery under a diagnosis of perforating duodenal ulcer. During surgery, we identified massive biliary ascites in the peritoneal cavity and bile leakage from the gallbladder. Duodenal serosa were normal. We conducted cholecystectomy, intraoperative choledochography, and abdominal drainage. A 0.2-cm defect was found in the body of the resected gallbladder. No gallbladder stones or thickening of the gallbladder wall were recognized. Culture of biliary ascites yielded no bacterial growth. Histologically, neutrophil and lymphocyte infiltration was observed, but other parts of the gallbladder wall showed less inflammation. The definitive diagnosis was idiopathic perforation of the gallbladder. ©2006 The Japanese Society of Gastroenterological Surgery.