Presentation
Features of acute cholecystitis include right upper quadrant pain and fever.
Patient Data
Active arterial blush from the posterior branch of the cystic artery, with large-volume hemoperitoneum.
Hyperdense material anterior to the gallbladder at the point of rupture demonstrates contrast extravasation and contrast pooling on the PV phase.
Overlying hyperdense material in the right sub-diaphragmatic space may represent a sentinel clot.
Case Discussion
Gallbladder perforation is an uncommon but critical complication of acute cholecystitis. Clinically indistinct, both acute cholecystitis and gallbladder perforation require imaging to guide management 1.
The most common perforation site is the fundus due to its poor blood supply 2; thus, vascular complications resulting from gallbladder perforation are infrequent. This case demonstrates perforation and active hemorrhage from the posterior branches of the cystic artery.
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