The case was suspected as perforated viscus due to sudden deterioration and positive peritoneal signs, non contrast CT study raised the suspicion of perforated gallbladder due to preferential pericholecystic fluid collection and adjacent fat stranding, a concealed perforated peptic ulcer was the second deferential.

Then aspiration of free peritoneal fluid done under ultrasound guidance and was bile, confirming the diagnosis of perforated gallbladder, surgeon Dr. Qusay Al Obaidi confirmed the diagnosis after open laparotomy, about 1 cm defect in gallbladder wall was identified.