Idiopathic perforation of the gallbladder: report of a case and a review of the Japanese literature.

A 79-year-old man was admitted to our hospital because of severe epigastric pain. Ultrasonography and computed tomography revealed a slightly distended gallbladder with a small amount of free intraabdominal fluid. At emergency laparotomy, perforation of the gallbladder was recognized and thus a cholecystectomy was performed. Histopathologically, localized necrosis was seen at the site of perforation: however, the inflammation of the surrounding tissue was mild and no thrombus was detected within the intramural vessels. In addition, the gallbladder contained no stones and a bile culture was negative. Postoperatively, the diagnosis of idiopathic perforation of the gallbladder was established. The findings of this case help to emphasize the importance of considering this disorder in elderly patients presenting with peritonitis of unknown origin.