title: Gallbladder perforation associated with carcinoma of the duodenal papilla: a case report.
abstract: BACKGROUND
  Gallbladder perforation is a rare clinical condition, which mostly occurs following acute cholecystitis associated with cholelithiasis. A tumor of the ampulla of Vater causes gradually progressive symptoms, and is rarely associated with perforation of the gallbladder.
  
  
  METHODS
  A 56-year-old man with carcinoma of the ampulla of Vater presented with spontaneous gallbladder perforation and localized bile peritonitis. He complained of right upper abdominal pain, and laparotomy revealed perforation of the gallbladder with no gallstones. Postoperative upper gastrointestinal endoscopy demonstrated a slightly enlarged duodenal papilla, and biopsy revealed adenocarcinoma of the ampulla. Pylorus-preserving pancreaticoduodenectomy was performed subsequently.
  
  
  CONCLUSIONS
  Ampullary carcinoma can be associated with gallbladder perforation and present with acute manifestations. Immediate surgical treatment is required for this condition.
authors.affiliation: Department of Surgery, Ome Municipal General Hospital, 16-5, Higashi Ome 4-chome, Ome-shi, Tokyo, 198-0042, Japan. hosaka-a@umin.ac.jp
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hosaka
authors.forename: Mikiko
authors.initials: M
authors.lastname: Nagayoshi
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Sugizaki
authors.forename: Yukiyoshi
authors.initials: Y
authors.lastname: Masaki
mesh_terms: D015746:Abdominal Pain; D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D014670:Ampulla of Vater / Q000473:pathology*; D003138:Common Bile Duct Neoplasms / Q000473:pathology* / Q000601:surgery; D005704:Gallbladder / Q000473:pathology*; D005705:Gallbladder Diseases / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D010538:Peritonitis / Q000175:diagnosis; D012422:Rupture, Spontaneous; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome