Abstract
An 83-year-old man presented with abdominal pain and nausea. On admission, an abdominal radiograph and ultrasonogram showed no remarkable findings, except for a slight swelling of the intestine. A contrast-enhanced computed tomography examination showed fluid collection around the liver. An emergency laparotomy was performed 26 hours after the onset of symptoms, and biliary peritonitis without perforation of either the digestive or biliary tracts was observed. A cholecystectomy with biliary drainage was performed. Although inflammatory changes in the gallbladder were not observed, the wall of the gallbladder was thin and a deep Rokitansky-Aschoff (R-A) sinus was present, especially at the fundus. Biliary transudation from the gallbladder as a result of a thin gallbladder wall and a deep R-A sinus, such as in this case, is quite rare.
