An Unusual Presentation of Gall Bladder Perforation as an Anterior Abdominal Wall Abscess

Abstract

A lump in the abdominal wall in right upper quadrant of abdomen can be because of a myriad of reasons and a ruptured gall bladder is one of the least suspected underlying causes. Overall, gallbladder perforation is quite serious an entity with high morbidity and mortality rates and hence early detection of this entity and subsequent needed interventions are extremely important for successful treatment of the patient.  We hereby report a case of a perforated gallbladder secondary to underlying acute calculous cholecystitis. The patient had presented with a painful swelling over right upper quadrant of abdomen with no septic complication and stable vitals. Upon cross sectional imaging it was diagnosed as acute calculus cholecystitis with rupture of gallbladder and adjacent pericholecystic and anterior abdominal wall abscess formation. It was managed with percutaneous pigtail placement under ultrasound guidance and was discharged with stable vitals with pigtail-in-situ after 6 days. Pigtail was functional and definitive therapy in the form of interval cholecystectomy was undertaken after a gap of 3 months which was uneventful. Appropriate identification of cause and subsequent intervention is imperative to patient’s well-being. Also not rushing into a cholecystectomy in an acutely inflamed gall-bladder is a very good decision to prevent inadvertent bile duct injuries.