Sonographic findings in perforation of the gallbladder

The sonographic findings in 13 patients with proven gallbladder perforation are described. Two patients were scanned immediately before and after gallbladder perforation. The sonographic findings before gallbladder perforation were gallbladder distension (one case) and gallbladder wall edema (one case). Pericholecystic collections develop after gallbladder perforation. These collections have a varied sonographic appearance ranging from anechoic to complex collections, and their internal characteristics seem to depend on the duration of the pericholecystic process. The residual gallbladder lumen or calculi can be identified within or peripheral to the pericholecystic process. The most acceptable mechanism for perforation of the gallbladder is: (1) impaction of a calculus in the cystic duct; (2) gallbladder distension due to secretion into its lumen by mucous glands located in the walls of the gallbladder; (3) vascular impairment of the gallbladder due to distension of the viscus; and (4) ischemia, necrosis, and perforation of the gallbladder wall. Gallbladder perforation is a significant complication of acute cholecystitis associated with morbidity and mortality. Detection of this complication of acute cholecystitis by clinical means is difficult since the patient's symptoms are similar to those of uncomplicated acute cholecystitis. The inherent resolution of sonography offers an excellent display of the gallbladder and surrounding tissues allowing detection of pericholecystic collection secondary to gallbladder perforation.