An unusual presentation of acute gallbladder perforation: a case report from a tertiary care-centre in Visakhapatnam, India

Gallbladder perforation is an uncommon but potentially life-threatening complication of acute cholecystitis. Clinical presentation may be atypical, particularly in elderly patients, making early diagnosis challenging. We report an unusual case of free perforation of a gangrenous gallbladder with a relatively stable clinical presentation. A case of an 85 year old female presenting with acute abdominal pain was evaluated clinically and radiologically. Laboratory investigations and contrast-enhanced computed tomography (CT) were performed, followed by operative assessment and postoperative follow-up. An 85-year-old woman presented with three days of progressively worsening generalized abdominal pain associated with diarrhea and chills. Examination revealed epigastric and right hypochondrial tenderness with a positive Murphy's sign. CT demonstrated an irregularly enhancing gallbladder with multiple wall defects, extensive inflammatory changes, and free intraperitoneal fluid, suggestive of perforated gangrenous cholecystitis. Laparoscopy revealed approximately 1 litre of free bile and a gangrenous gallbladder with perforation involving the fundus and body. Laparoscopic cholecystectomy, peritoneal lavage, and drain placement were performed. The postoperative course was uneventful, and the patient was discharged on postoperative day 5. Histopathology revealed acute on chronic cholecystitis. Free gallbladder perforation may present atypically despite severe underlying pathology. CT is valuable for diagnosis, and laparoscopic cholecystectomy with adequate peritoneal lavage can provide effective treatment in appropriately selected patients.