The patient presented with right upper quadrant pain that appeared on the same day, a single episode of vomiting, and a rise in temperature. Lab tests were remarkable for leukocytosis with neutrophilia.
History of diabetes mellitus type 2, hypertension, hyperlipidemia, and moderate-to-severe left ventricular failure.

The ultrasound and CT examinations were performed only several hours apart.

Following CT, the patient underwent exploratory laparoscopy. Biliary peritonitis in all four quadrants was observed, at which point conversion to laparotomy was performed. A perforated gallbladder was excised.

Upon revision of the radiological exams, while there is perceived interruption in the integrity of the gallbladder fundus wall, one cannot assuredly diagnose gallbladder perforation. In the appropriate clinical context, abnormal radiological findings should raise the level of suspicion for complicated cholecystitis. ¹