An unusual case of type II spontaneous gallbladder perforation presenting as a right iliac fossa mass.

Abstract

Spontaneous gallbladder perforation (GBP) is a very rare clinical condition which is mostly associated with calculous cholecystitis. Neoplastic growths at ampulla of Vater usually present with progressive symptoms and are rarely associated with GBP. Type II GBP presents as a localized collection and abscess formation at the site of the perforation, but unusual presentation can be found. Definitive diagnosis in elderly patients presenting with a mass in the right iliac fossa (RIF) region could be quite difficult due to the wide range of potential pathologies of the different anatomical organs present there. Here we discuss an unusual presentation of GBP secondary to periampullary growth presenting as a RIF mass. An 84-year-old female presented with a history of right side lower abdominal pain and fullness for a period of about a month. She also complained of dyspeptic symptoms for roughly the same duration. She underwent contrast enhanced computed tomography (CECT) of the abdomen as an initial investigation which revealed a collection in the RIF region from GBP, and a periampullary growth causing complete obstruction of the biliary tract. Ultrasound guided drainage of RIF collection followed by Endoscopic Retrograde Cholangio-Pancreaticogrphy (ERCP) and stenting of the common bile duct (CBD) was arranged as palliative treatment, since patient was unfit for major therapeutic intervention, i.e. pancreatico-duodenectomy. This case illustrates the importance of cross-sectional imaging in the evaluation of patients with RIF masses, especially when they are not in the typical age for appendicular masses, and also highlights the variety of unusual pathologies that could possibly give rise to such mass lesions.