Spontaneous gallbladder perforation in a man with gallstone disease without known anamnesis of cholecystitis: Case report.

Introduction: Spontaneous gallbladder perforation is a rare complication of gallstone disease. It causes acute peritonitis with potentially fatal outcome.

Case Presentation: We present a case of spontaneous gallbladder perforation with challenging diagnosis.

Discussion: The diagnosis of gallbladder perforation should be considered in elderly patients presenting to the surgical emergency department with symptoms and signs of peritonitis even in the absence of pre-existing gallbladder disease. Spontaneous gallbladder perforation is a rare and potentially fatal diagnosis. In most reported cases, perforation occurred due to predisposing factors like acute cholecystitis, trauma or obstruction. In spite of rarity, spontaneous gallbladder perforation should be considered as differential diagnosis on examination of patients with sudden abdominal pain especially in cases of known cholecystolithiasis. Our patient had type 1 perforation according to Niemeier classification, the type associated with the highest mortality rate. The type of perforations has been reported as being difficult to recognize preoperatively, as with our patient with two inconclusive CT scans. This was due to the absence of classical symptoms of gallbladder perforation. CT is the modality of choice when gallbladder perforation is suspected.

Conclusion: We believe the reason for the spontaneous gallbladder perforation in the presented case was the presence of cholecystolithiasis. We acknowledge the importance of considering this diagnosis also in patients without previous signs of cholecystitis.