1995 Volume 56 Issue 5 Pages 1034-1038
This paper reports a patient with perforation of the gallbladder without gall stone who was saved by an emergency operation. An 81-year-old woman, who was operated on for a flucture of the neck of the femur, complained of severe abdominal pain on the fifth hospital day and consulted us. Clinical examination revealed muscular gurding on the upper abdomen and abdominal CT showed the distended gallbladder and a little fluid on the anterior surface of the left lobe of the liver. Intraperitoneal free air was not detected on a plane abdominal X-ray film and abdominal CT. Abdominal ultrasonography showed the distended gallbladder, but pericystic fluid correction was not detected. An emergency laparotomy was performed for peritonitis of unknown origin, and gallbladder perforation was found out. Cholecystectomy was carried out. Any gall stone was not recognized. Histological findings revealed the infiltration of inflammatory cells around the perforation without thrombus nor embolus in the cystic artery. The definite diagnosis of gallbladder perforation due to acute crisis of chronic chorecystitis without gall stone was achieved. Postoperative course was good and on the 49th postoperative day she was referred to another hospital for rehabilitation. We conclude that acute cholecystitis with muscular gurding and intraperitoneal fluid correction is the indication of the emergency operation.
