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.