Spontaneous gall bladder perforation masquerading as a large abdominal lump: An uncommon presentation of a common entity

Abstract

Gall bladder perforation (GBP) is an uncommon complication of acute cholecystitis. Usually patients with GBP present with localized or diffuse peritonitis defending on their ability to localise the site of perforation. We recently cared for a 65-year-old female with GBP who presented to us with a painful large anterior abdominal lump and jaundice. On investigations, a large subcapsular liver collection was identified along with a perforation at the fundus of gall bladder and a calculus at the lower end of the common bile duct (CBD). The patient underwent pigtail catheter drainage of the collection under ultrasound guidance, endoscopic retrograde cholangiopancreatography, and papillotomy for CBD stone retrieval, followed by elective laparoscopic cholecystectomy with uneventful recovery. This case report highlights the fact that in a patient with gall stone disease presenting with a painful abdominal lump, the possibility of underlying GBP should be considered and the treatment should be individualised based on clinical condition of the patient.