Spontaneous hemorrhagic gallbladder perforation

Case contributed by Dr Julian L. Wichmann

Presentation

History of cirrhosis with portal hypertension. Sudden decrease of hemoglobin and positive shock index.

Patient Data

Age: 55 years
Gender: Female
  • Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

Idiopathic perforation of the gallbladder with intraperitoneal dislocation of gallstones. There is diffuse venous hemorrhage from the gallbladder. Coronal view improves visualization of the perforated gallbladder with diffuse venous hemorrhage.

For helpful comparison, the third CT image stack demonstrates a previous CT of this patient with an intact gallbladder with cholecystolithiasis. 

Case Discussion

Idiopathic perforation of the gallbladder (IPGB) is a rare condition. While it has been reported that thrombosis in the intramural vessels is related to this disease, the main underlying pathologic mechanisms are still unknown.1

This patient presented with a positive shock index, shortness of breath but no quadrant-specific abdominal pain. Due to a sudden decrease in hemoglobin in a patient with known cirrhosis and esophageal varices, CT angiography was performed to rule out active abdominal bleeding. IPGB was an incidental finding in this patient but is well visualized as some of the gallstones are now intraperitoneal. In addition, there is diffuse venous hemorrhage from the gallbladder. Open cholecystectomy was performed and the patient went to the ICU.

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