Spontaneous haemorrhagic gallbladder perforation
History of cirrhosis with portal hypertension. Sudden decrease of hemoglobin and positive shock index.
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Series 1 + 2 demonstrate idiopathic perforation of the gallblader with intraperitoneal dislocation of gallstones. There is diffuse venous hemorrhage from the gallbladder. For better comparison, Series 3 demonstrates a previous CT scan of this patient with an intact gallbladder with cholecystolithiasis.
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.
- Namikawa T, Kobayashi M, Okabayashi T, Okamoto K, Akimori T, Sugimoto T et al. Clinicopathological analysis of idiopathic perforation of the gallbladder. Surg Today. 2007;37(8):633-7. Pubmed citation
- Saha SP, Irons RP, Couture MM. Perforation of the gallbladder with massive intraperitoneal hemorrhage. Int Surg. 1977 Jun-Jul;62(6-7):351. Pubmed citation
- Vijendren A, Cattle K, Obichere M. Spontaneous haemorrhagic perforation of gallbladder in acute cholecystitis as a complication of antiplatelet, immunosuppressant and corticosteroid therapy. BMJ Case Rep. 2012 Jul 9;2012 Pubmed citation