Gallbladder perforation presenting as a hepatic neoplasm

Abstract

Sangara Narayanan, Ashwin Rammohan, Jeswanth Sathyanesan, Ravichandran Palaniappan, Manoharan Govindan

Perforation of the gallbladder is a rare, but potentially fatal complication of acute cholecystitis. Gallbladder perforations presenting electively as a space-occupying lesion of the liver are its rarest presentation. We report one such case, which was a diagnostic conundrum. A 50-year-old female presented with upper abdominal pain of 6 months duration. On examination, she was afebrile and had minimal tenderness in the right upper quadrant. All of her blood investigations were unremarkable, and her imaging showed features suggestive of a biliary cystadenoma. Intra-operatively, she was found to have a perforated gallbladder with intrahepatic extension. Cholecystectomy with abscess drainage was done, and her post-operative period was uneventful. Gallbladder perforations can have a myriad of presentations. We report a rare case of a perforated gallbladder mimicking a biliary cystadenoma. A high index of suspicion along with prudent decision-making can help in accurate pre-operative diagnosis, thereby avoiding intraoperative surprises and unnecessary morbidity, especially in cases where a benign pathology mimics malignancy