Spontaneous gallbladder perforation presenting as biliary ascites

Abstract

A 36-year-old man presented with increasing abdominal distention and breathlessness for 3 days. He had an alcohol binge before the onset of symptoms, but there was no history of trauma, loss of consciousness, or vomiting. On examination, he was jaundiced and tachypneic and had tense ascites. There was no abdominal guarding or rigidity. Laboratory results revealed a hemoglobin level of 13.8 g/dL, white blood cell count of 11,300/mm3 with polymorphs of 70%, blood urea nitrogen of 35 mg/dL, creatinine of 1.0 mg/dL, total bilirubin of 4.8 mg/dL with direct bilirubin of 3.0 mg/dL, aspartate aminotransferase of 120 U/L, alanine aminotransferase of 80 U/L, alkaline phosphatase of 380 U/L, gamma glutamyl transpeptidase of 120 U/L, and total protein of 6.6 g/dL with albumin of 3.6 g/dL.