A Case of Idiopathic Perforation of the Gall Bladder in a Young Adult Patient

Seiji Mega, Ryousuke Kawasaki, Kazuhiro Iwai, Toshimichi Asano and Kazuaki Hazama

Division of Surgery, Oji General Hospital

A 24-year-old man admitted for sudden abdominal pain was found in abdominal computed tomography (CT) to have a fluid collection in the subphrenic space and laboratory data and abdominal signs suggestive of diffuse peritonitis necessitating emergency surgery. We found massive biliary ascites in the peritoneal cavity and bile leakage from the gallbladder and a 3 mm defect in the body of the gallbladder near Hartmann's pouch. Duodenal serosa were normal. We conducted cholecystectomy and abdominal drainage. No gallbladder stones or thickening of the gallbladder wall were seen and culture of biliary ascites yielded no bacterial growth. The postoperative course was good and the man was discharged 10 days after surgery. Histologically, small thrombi occurred in the gallbladder wall near the perforation, but other parts of the gallbladder wall showed less inflammation. The definitive diagnosis was idiopathic perforation of the gallbladder.

Key words
idiopathic perforation, gallbladder, diffuse peritonitis

Reprint requests
Seiji Mega Division of Surgery, Oji General Hospital
3-4-8 Wakakusa-cho, Tomakomai, 053-8506 JAPAN

Accepted
October 29, 2007

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