Gallbladder perforation associated with carcinoma of the duodenal papilla: a case report

Abstract

BackgroundGallbladder perforation is a rare clinical condition, which mostly occurs following acute cholecystitis associated with cholelithiasis. A tumor of the ampulla of Vater causes gradually progressive symptoms, and is rarely associated with perforation of the gallbladder.Case PresentationA 56-year-old man with carcinoma of the ampulla of Vater presented with spontaneous gallbladder perforation and localized bile peritonitis. He complained of right upper abdominal pain, and laparotomy revealed perforation of the gallbladder with no gallstones. Postoperative upper gastrointestinal endoscopy demonstrated a slightly enlarged duodenal papilla, and biopsy revealed adenocarcinoma of the ampulla. Pylorus-preserving pancreaticoduodenectomy was performed subsequently.ConclusionAmpullary carcinoma can be associated with gallbladder perforation and present with acute manifestations. Immediate surgical treatment is required for this condition.

Intrahepatic perforation of the gallbladder causing liver abscesses: case studies and literature review of a rare complication

“…In the case of a gallbladder perforation without cholelithiasis, an ampullary tumour should be considered to be the possible underlying condition. 9 If suspicion of malignancy is raised on abnormal radiological findings, patients should be discussed in a Ultrasonography is first-line imaging for patients presenting with the typical symptoms of acute cholecystitis, and does not differ greatly if a gallbladder perforation is present. Initial ultrasound findings can vary from thickening of the gallbladder wall (largest diameter, >3 mm) to only gallbladder distension (largest diameter, >3.5-4.0 cm).…”

An unusual case of type II spontaneous gallbladder perforation presenting as a right iliac fossa mass.

“…Peri-ampullary growths usually present with a history of progressive obstructive jaundice associated with constitutional symptoms such as loss of weight and loss of appetite. Acute manifestations of this type of biliary obstruction are rare [12]. Distal obstruction of the biliary tract due to the peri-ampullary growth compounded by reduced vascularity in old age probably predisposed to spontaneous GBP in this presentation.…”

“…Imaging plays a major role in making an accurate diagnosis of GBP [12,13]. Ultrasound scan and CT scan are important imaging modalities in GBP.…”

Spontaneous acalculous gallbladder perforation in a man secondary to chemotherapy and radiation

“…[ 12 , 13 ] Gallbladder wall thickening, pericholecystic fluid collection, and the streaky omentum or mesentery is common findings of gallbladder perforation. [ 1 , 14 ] Detection on imaging such as CT scans or ultrasonography can be difficult in small perforations and the findings are usually nonspecific. The presence of extra-luminal gallstones would be a suggestive sign, but it was not seen in this case.…”