Acalculous cholecystitis with gallbladder perforation in a critically ill trauma patient: An unexpected complication

Gallbladder perforation is a rare complication following blunt abdominal trauma, largely due to its anatomical protection within the liver parenchyma. We present the case of a male in his 50s who sustained multiple traumatic injuries following high-impact motor vehicle collision. He was initially admitted with haemodynamic compromise necessitating emergency trauma laparotomy, splenectomy and a traumatic diaphragmatic hernia repair. There was no evidence of gallbladder or liver injury in the preoperative abdominal CT scan or laparotomy. Despite this, he developed new RUQ pain, anaemia and early signs of sepsis on day 17 day after his initial presentation with repeat imaging confirming gallbladder perforation consistent with acalculous cholecystitis in the context of critical illness. This was managed radiologically with a percutaneous cholecystostomy drain. This case illustrates the diagnostic challenges and management of acalculous cholecystitis with perforation in critical illness, highlighting ischaemia, biliary stasis, and hypoperfusion mechanisms.