Spontaneous Gall Bladder Perforation Presenting as a Diagnostic Challenge: a Case Series

Acute biliary tract disease is a common condition in adults. However, spontaneous gall bladder perforation is infrequent and somewhat common in children and elderly especially those with co-morbidity. Till date, all recorded cases are secondary to a coexisting illness. Gall bladder perforation is almost an exclusive complication of cholecystitis, with or without cholelithiasis. The diagnosis of spontaneous perforation of gall bladder is challenging and requires a high degree of clinical suspicion, and it carries a high morbidity and mortality if left untreated. The clinical suspicion is very well supported by radiological investigations like USG and CT scan. We present a case series of 4 patients with spontaneous gall bladder perforation. Firstly, a 45-year-old lady, presented to our side with acute abdomen, with neither any comorbid condition nor any similar events in the past, with gangrenous, perforated gall bladder, with multiple small calculi and managed by open cholecystectomy. Another patient, a 65-year-old gentleman, presenting with acute abdomen, with similar finding of gangrenous gall bladder perforation with large calculi in lumen. Similar clinical picture and per-operative findings were also present in our third patient. Lastly, a patient presenting to our side with acute intestinal obstruction with peritoneal collection, which on exploration, had 2 L of bile in peritoneal cavity with bile-stained bowel with perforation in gall bladder near fundus.