2026 Volume 40 Issue 2 Pages 211-217
A 61-year-old man was referred to our department with a chief complaint of right-sided abdominal pain. He had tenderness in the right hypochondrium. Blood biochemistry showed no obvious abnormalities except for mild exacerbation of inflammation. Abdominal CT showed some high density areas at fundus of the gallbladder wall and mild fatty tissue opacity around the gallbladder. The patient was diagnosed with acute cholecystitis and was to be treated with conservative treatment using antibiotics. However, the pain became more severe, physical findings suggestive of peritonitis were noted. A second CT scan showed ascites accumulation in the abdominal cavity, mainly around the liver. Emergent surgery was performed with a diagnosis of generalized peritonitis. Intraoperative findings revealed intraperitoneal bile collection around the liver and a pinhole perforation of the gallbladder. Laparoscopic cholecystectomy and intraperitoneal drainage was performed. The patient had a good postoperative course and was discharged from the hospital on the seventh postoperative day. The pathological findings of the gallbladder were chronic cholecystitis. The clinical diagnosis was a rare idiopathic perforation of the gallbladder.
