Unexpected manifestations of a perforated gallbladder: a case study and imaging assessment

Gallbladder perforation can be caused by delayed diagnosis of cholecystitis and, more rarely, trauma. Despite advancements in imaging modalities, diagnosis is often challenging, leading to further delays in diagnosis and increased morbidity and mortality. In this report, we discuss a 49-year-old Caucasian male who presented to the emergency department with severe, out-of-proportion pain and fevers following a mechanical fall. Blood tests were unremarkable, but portal venous contrast-enhanced CT of the abdomen-pelvis showed a thickened gallbladder with perihepatic fluids, and CT of the chest revealed bilateral lobar atelectasis. After a period of conservative management, the patient eventually underwent diagnostic laparoscopy, revealing a perforated gallbladder with biliary peritonitis.