A rare asymptomatic case of type II gallbladder perforation with a large hepatic abscess, associated to calculi: role of imaging

Abstract Gallbladder perforation (GBP) is a rare condition, especially when asymptomatic or not associated with cholecystitis. It is often linked to cholelithiasis, specifically with stones exceeding 20 mm in diameter. The fistulous tract commonly involves the gallbladder fundus, leading to bile extravasation and intraparenchymal abscess formation. Accurate diagnostic imaging is crucial particularly in asymptomatic patients. Abdominal US serves as the initial diagnostic tool, while contrast-enhanced computed tomography (CT) provides detailed images for confirmation. Additionally, non-contrast magnetic resonance imaging (MRI) serves as a second-level investigation to enhance diagnostic accuracy. The diagnosis of gallbladder perforation requires a comprehensive evaluation utilizing multiple imaging modalities, including US, CT, and MRI, to confirm the presence of perforation and guide appropriate management strategies. Imaging plays a fundamental role in follow-up assessments, evaluating response to pharmacologic or minimally invasive surgical treatments (percutaneous drainage) or invasive surgery.