An Unusual Presentation of Gall Bladder Perforation with Hepatic Subcapsular Collection

Abstract

A 60 year old male presented with Gall Bladder perforation in a case of calculous cholecystitis with perforation at the tip of the fundus. The perforation lead to collection of bile under the liver capsule. This case is unusual as clinically suggestive of liver abscess and the perforation didn't lead to biliary peritonitis. Gall Bladder perforation is life threatening event associated with increased morbidity and mortality. Cholecystectomy with peritoneal lavage is the treatment of choice.

Intrahepatic Type II Gall Bladder Perforation Secondary to Acute Acalculous Cholecystitis

“…Gall bladder perforation is a rare complication of acute cholecystitis. The pathophysiology is explained by acute inflammation of the gall bladder with subsequent ischaemia and necrosis resulting in perforation of the gall bladder wall [1]. The fundus of the gall bladder is commonly perforated compared to other regions due to the relatively poor blood supply.…”

“…Rarely, the perforation may occur into the liver parenchyma leading to the formation of an intrahepatic abscess known as type II perforation. Long-standing cholecystoenteric fistula is known as type III perforation [1,3]. Although uncomplicated acute cholecystitis occurs commonly in middle-aged females, gall bladder perforation is associated with a male preponderance, especially in the elderly [3].…”

“…Infrequently, clinical features are subtle during the onset with rapid clinical deterioration resulting in difficulties in the diagnosis and management of this condition [1,2]. Gall bladder perforations commonly occur in patients with comorbidities and in association with gall stones [1,2]. We report a rare occurrence of intrahepatic type II perforation of the gall bladder in a previously healthy elderly male with acalculous cholecystitis.…”

“…Gall bladder perforation is a rare but serious complication of acute cholecystitis with an overall incidence between 3 and 15% [1]. Infrequently, clinical features are subtle during the onset with rapid clinical deterioration resulting in difficulties in the diagnosis and management of this condition [1,2]. Gall bladder perforations commonly occur in patients with comorbidities and in association with gall stones [1,2].…”

A rare case mimicking positron emission tomography/computed tomography mismatch: Hepatic subcapsular hematoma

“…Subcapsular collections of bile, air or blood in the liver have been described following transhepatic procedures due to the leakage of bile and blood from the percutaneous puncture at the surface of the liver. [ 1 2 3 4 5 6 7 ] In the presented case, the subcapsular collection led to a mismatch between functional and anatomical boundaries of the liver. The HU values of extravasated blood during acute phase were similar to that of liver parenchyma, and it is difficult to diagnose with unenhanced CT.[ 8 ] This could be explained with the generation of fibrin fibrils and globin molecules.…”