Perforated Gangrenous Gallbladder in an Asymptomatic Patient

Abstract

Acute cholecystitis or inflammation of the gallbladder is a common cause of hospitalizations. A percentage of those patients will progress to gangrenous cholecystitis and perforation. This medical emergency can lead to peritonitis, which has increased morbidity and mortality. The first-line modality for the diagnosis of acute cholecystitis is an ultrasound, but if it is inconclusive, then a computed tomography (CT) scan may be beneficial. Gangrenous cholecystitis and perforation have been reported in asymptomatic diabetic patients secondary to diabetic neuropathy and/or gallbladder ischemia leading to nerve denervation. Yet, here we present the case of an asymptomatic non-diabetic patient with gangrenous gallbladder perforation that was treated with antibiotics and drain placements. Diagnosis and treatment involve the collaboration between primary care, interventional, and diagnostic services to appropriately manage these patients. This case demonstrates that clinicians should have a low threshold to conduct CT scan of the abdomen, especially when there is a sudden resolution of pain.

Acute Cholecystitis Presenting With Septic Shock as the First Presentation in an Elderly Patient

“…In all previously reported cases of perforated GC, the patients were older (>65) and showed a cholecystitis complication (perforated or gangrenous gallbladder) as the first presentation; however, all of them were stable at presentation [9,[13][14][15]. Conversely, our patient exhibited septic shock as the first presentation.…”

“…Consequently, morbidity and mortality increase. GC has several risk factors such as old age, diabetes mellitus, male sex, leukocytosis, and coronary heart disease [9]. Although gallbladder perforation is a rare complication of acute cholecystitis, it can be life-threatening, with a mortality rate of 12-42% [10].…”

Concealed gallbladder perforation: a rare case report

“…Certain cases have been reported of asymptomatic gallbladder perforations in literature [ 1 ]. Like in the index case, this can happen in those whose perforation is sealed by the omentum and/or bowel or in those who are diabetic due to the related neuropathy and ischemic changes.…”

“…Similarly to our case, Faraji et al . also presented a case where the patient had resolved abdominal signs but the CT scan revealed a perforated gallbladder while the ultrasound was negative [ 1 ]. This emphasizes that surgeons need to have a high index of suspicion whenever symptoms are either vague or resolved, and as ultrasonography can miss the pathology, a CT scan should be opted for such scenarios [ 7 ].…”

“…Gallbladder perforation causes peritonitis hence is a surgical emergency [ 1 ]. Inflammation of the gallbladder usually causes perforation, which can be due to cholecystitis or malignancy [ 1–2 ]. A standard management approach involves a fine balance between the diagnostic and interventional services for these patients.…”