Unusual presentation of perforation of the gallbladder

Perforation of the gallbladder is a known sequela of acalculus cholecystitis or trauma. A perforated gallbladder may be acute or chronic and can present with vague symptoms making the diagnosis difficult. With delayed recognition there is increased morbidity and mortality. The preoperative diagnosis requires an awareness of the symptoms and signs of acalculus cholecystitis as well as factors that predispose to the development of the diseased gallbladder. Awareness of the radiographic findings associated with a perforated gallbladder and acalculus cholecystitis is also important. The following is a case report of a child with a perforated gallbladder with a radiographic presentation not previously described. A review of the clinical pathogenesis and reported radiographic findings is also included.