A CASE OF IDIOPATHIC PERFORATION OF THE GALLBLADDER

Abstract

We experienced a case of perforation of the acalculous gallbladder, so called “idiopathic perforation of the gallbladder”. A 94-year-old woman who was admitted to the hospital because of severe pain of the upper abdomen. Spontaneous pain and tenderness were recognized in the epigastric region. On admission neither laboratolry nor abdominal X-ray examination revealed abnormality. Both abdominal sonography and CT revealed a slight thickness of the gallbladder wall and a small quantity of ascites. Because no symptomatic remission was attained with conservative treatment and muscle defence became terrible gradually, panperitonitis was suspected. The patient was operated on 14 hours after the onset of symptoms. During surgery bilialy ascites was found in the perineal cavity and a black-colored change 0.6cm in size at the fundus of the gallbladder and leakage of bile juice from the site were noted. Cholecystectomy and abdominal drainage were performed. There were no stones in the gallbladder and culture of the bile juice was negative for bacteria. Histologically, an autolysis of the wall in the perforated site was seen but no infiltration or arterial thrombus existed. The difinitive diagnosis of ideiopathic perforation of the gallbladder was made.
Post operative course was unevenful. The patient was discharged from the hospitl two weeks after the operation.