Abstract
The main cause of gall bladder perforation is acute cholecystitis with stones, but the combination of free air in the abdominal cavity is a very rare condition. Here, we report a rare case of gall bladder perforation with massive free air in the abdominal cavity. A 70-year-old man was transported to our hospital because of sudden abdominal pain during medical treatment for hypertension, cerebral infarction and diabetes mellitus in another hospital. On examination, there was severe rebound tenderness in the upper abdomen with muscular guarding. Abdominal X-ray and computed tomography scan showed massive free air in the abdominal cavity. There was a calculus in the neck of the gall bladder with normal wall thickness and no evidence of emphysematous change. Under the diagnosis of perforation of the digestive tract, an emergency operation was performed. In the abdominal cavity, there was massive biliary ascites. However, the perforation site was not observed in the digestive tract, but in the neck of the gall bladder with a 3 mm hole. Cholecystectomy was performed, and cultures of the ascites detected Escherichia coli. Gall bladder perforation should be considered in a differential diagnosis for patients presenting with free air in the abdominal cavity and an unknown etiology.
