A Case of Gallbladder Perforation Accompanied by Bile Retention in the Retroperitoneal Space

Abstract

We report herein on a case of gallbladder perforation that was accompanied with bile retention in the retroperitoneal space. A 74-year-old woman presented with abdominal pain from the day before admission. She was transferred to our hospital. A physical examination revealed tenderness of the right upper abdomen. A blood examination revealed a white blood cell count of 17,000/μL and a C-reactive protein level of 9.52 mg/dL. An abdominal contrast CT scan revealed a higher CT density of the fat tissue around the third portion of the duodenum and fluid retention in the retroperitoneal space. The patient was diagnosed as having perforation of the duodenum, and emergency surgery was performed. Although an intraoperative examination revealed bile ascites in the peritoneal cavity, we could not detect the perforated site of the duodenum. Bile retention was also observed in the retroperitoneal space around the right kidney and the second portion of the duodenum. The serosa of the gallbladder had partially collapsed. It was thought that the bile had broken out from the gallbladder wall and into the retroperitoneal cavity. A cholecystectomy and peritoneal drainage were performed. The patient was discharged on Day 11 with a good postoperative course.