Acute cholecystitis with fundal perforation: A rare but life-threatening complication

Abstract

Gallbladder perforation is a rare but life-threatening complication of acute cholecystitis, occurring most commonly at the fundus due to its relatively poor vascular supply. Elderly males and patients with comorbidities such as diabetes face a higher risk of perforation, and the condition may mimic uncomplicated acute cholecystitis, making early diagnosis challenging. We report the case of a 72-year-old diabetic male who presented with a 5-day history of right upper quadrant pain, fever, and elevated inflammatory markers. Ultrasound demonstrated a markedly distended gallbladder with wall edema, thickening, multiple small calculi, sludge, and minimal pericholecystic fluid. Emergency laparoscopic cholecystectomy revealed a thickened, gangrenous gallbladder with a sealed fundal perforation surrounded by bile and fibrin. Histopathology confirmed acute erosive, focal necrotic/perforated cholecystitis. The patient recovered uneventfully with appropriate postoperative management and was discharged in good condition. This case highlights the diagnostic difficulty of fundal perforation and emphasizes the importance of prompt surgical intervention to prevent progression to generalized peritonitis or abscess formation.