title: Acute free perforation of gall bladder encountered at initial presentation in a 51 years old man: a case report.
abstract: BACKGROUND
  Gallbladder perforation is a rare but life threatening event. We describe a case of gallbladder perforation encountered at initial presentation.
  
  
  METHODS
  A 51 years old male, without any known medical co-morbidity, presented with a 1-day history of sudden-onset abdominal pain and abdominal distension. On examination, his abdomen was distended with generalized tenderness on palpation. Abdominal x-ray showed no signs of intestinal obstruction or pneumoperitoneum. Computed tomography scan of the abdomen showed appearance suggestive of gallbladder perforation. The patient was taken to the operating room and a diagnostic laparoscopy was performed revealing yellowish green fluid in the peritoneum. Difficulty in visualization of the anatomy led to conversion of the procedure to an open laparotomy. Intra-operative findings included a perforation near the neck of the gall bladder in association with a 2 x 1 cm gall stone. Near-total cholecystectomy was performed and a single large gall stone was retrieved. The peritoneal cavity was washed with normal saline and a drain was placed. The rectus sheath was closed but the wound was kept open for healing by delayed primary closure. The patient's hospital course was uneventful and he was discharged from the hospital on the 3rd post-operative day. He returned to the clinic after one week whereby his drain was removed and his wound closed.
  
  
  CONCLUSIONS
  Gallbladder perforation is an unusual initial presentation of gallbladder disease. Early diagnosis of gallbladder perforation and immediate surgical intervention are of prime importance in decreasing morbidity and mortality associated with this condition.
authors: Department of Surgery, Section of General Surgery, Aga Khan University, (Stadium Road), Karachi, (74800), Pakistan. rehman.alvi@aku.edu
authors: Abdul Rehman
authors: AR
authors: Alvi
authors: Saad
authors: S
authors: Ajmal
authors: Taimur
authors: T
authors: Saleem