Introduction : Gallstone disease is the most common disorder of the gastrointestinal tract, affecting 10% to 15% of the population, however, majority of patients are widely asymptomatic and undiagnosed until complications arises. The objective of this report is to determine the risk factors associated with gallbladder perforation, as well as the management and preventive measures for the condition.

Methods : Literature review done through search with Pubmed. Search terms: gallbladder perforation; acute cholecystitis; acute appendicitis

Results : This is a case of an acute perforation of the gallbladder in a 34-year old male, presenting clinically as acute appendicitis. Intraoperatively, moderate amount of bile was noted intraabdominally through a Rockey-Davis incision. Decision was to proceed with an exploratory laparotomy through a midline incision. The appendix was retrocecally located and grossly normal. Adhesions were noted at the liver, stomach, transverse colon, peritoneum, and in the right upper quadrant area. The gallbladder was noted to be densely surrounded by omentum and with a point of rupture at the fundus of the gallbladder, with bile leaking from it.

Conclusions : Gallbladder perforation is rarely diagnosed pre-operatively, occurring about 3% to 10% in patients with acute cholecystitis. It has a high mortality rate and poor prognosis due to atypical clinical presentation. This leads to delayed diagnosis and treatment. It is therefore important to suspect perforation, clinically. Early diagnosis of gallbladder perforation and subsequent surgical intervention is of crucial importance. Diagnostic tests such as abdominal ultrasound and CT scan may contribute to the pre-operative diagnosis.