Acute cholecystitis with abdominal wall perforation: Case report [Colecistite acuta litiasica con perforazione nella parete addominale: Case report]

We describe the case of a gallbladder perforation in the abdominal rectal muscle. The patient arrived to Emergency Departement presenting clinical symptoms and signs and laboratoristic data referring to acute cholecystitis. After several diagnostic imaging, such as abdominal ultrasound, cholangio-MRI, CT, we found a purulent collection in the abdominal rectal muscle communicating with gallbladder’s fundus. Because of the elevated anesthesiologic risk and the improvement of the presenting symptomatology, we decided to procrastinate the surgical operation of cholecystectomy, which was performed after 42 days. We preferred to execute the traditional approach, than the laparoscopic one, proceeding to drain the purulent collection and then to retrograde cholecystectomy. The gallbladder perforation is a rare complication of acute cholecystitis with elevated morbidity and mortality. Its localization is usually the fundus of the viscus, which has the least blood supply. Its preoperative diagnosis, clinical and instrumental, is very often difficult and it is usually diagnosed in the operative room. There are several risk factors, such as age (>65 years), male gender, cardiovascular pathology, that increased the probability of gallbladder perforation