A case of spontaneous acalculous gallbladder perforation difficult to diagnose on computed tomography

Gallbladder perforation is a rare and life-threatening event. Accurately diagnosing gallbladder perforation without cholecystitis or gallstones is difficult. The patient was admitted with abdominal pain and was diagnosed with diffuse peritonitis the following day via computed tomography (CT). Laparoscopic findings revealed the accumulation of bile-like ascites and a thinned and soft gallbladder with slight leakage of bile juice from a pinhole perforation. Laparoscopic cholecystectomy and peritoneal lavage were then performed. In the present case, it was difficult to diagnose gallbladder perforation because of the lack of cholecystitis and gallstones in the CT findings. If preoperative CT shows an acute abdomen with peritoneal effusion, especially accumulated around the gallbladder, then gallbladder perforation may be considered as a primary lesion.