Gallbladder Rupture

Published: July 10, 2018
Last reviewed: July 10, 2018

Gallbladder rupture is a rare but life-threatening complication of gallbladder disease or injury. It can refer either to a sudden gallbladder burst or a gradually developing hole in the gallbladder wall. It most commonly occurs in people with gallstones who have gallbladder inflammation [1].

Symptoms and Signs

Symptoms and signs of gallbladder rupture can include [1,2]:

  • Sudden severe pain in the upper right or upper central abdomen, which can last for several hours, fade away and return several times
  • Nausea and vomiting
  • High fever
  • Tenderness below the right rib cage
  • Jaundice

The gallbladder can rupture soon after the onset of gallbladder disease or days to weeks later [1]. A doctor usually cannot distinguish gallbladder rupture from other acute gallbladder conditions from the symptoms and signs alone.


The gallbladder can rupture due to:

  • Acute cholecystitis with gallstones (in 2-18% cases) [8]
  • Acute cholecystitis without gallstones (in 10-20% cases) [8]
  • Emphysematous cholecystitis – infection of the gallbladder with the accumulation of air in it (mainly in people with diabetes)
  • An accident during laparoscopic gallbladder removal (in 15-30% cases) [1]
  • Gallbladder cancer (rare) [4]
  • A blunt injury (rare) [8]
  • Ascariasis, caused by parasitic worms (rare) [7]

Risk factors for gallbladder rupture include [1,2,10]:


Gallbladder rupture can lead to one or more life-threatening complications [1]:

  • Biliary peritonitis – inflammation of the abdominal membrane triggered by spilled bile
  • Hepatic abscess – a collection of pus near the liver
  • Pneumonia – lung infection
  • Acute pancreatitis – inflammation of the pancreas
  • Acute kidney failure – kidney damage with an impaired urine excretion
  • Sepsis – the blood infection
  • Gallstone ileus – a blockage of the small intestine by a big gallstone that has passed from the gallbladder


The following investigations can help to detect gallbladder rupture [1,2,11]:

  • Abdominal ultrasound
  • Upper abdominal computed tomography (CT)
  • Blood tests, which often reveal high white blood cell count (WBC)
  • Biliary scintigraphy (HIDA scan), which can reveal bile leak

Gallbladder perforation

Picture 1. An ultrasound image of gallbladder rupture
the arrow points to a defect in the gallbladder wall
(source: Ultrasoundcases, by permission)

Investigations only sometimes clearly show gallbladder rupture, which can often be diagnosed only at the time of the surgery [2].


A surgeon can treat acute gallbladder rupture by a minimally invasive laparoscopic gallbladder removal [2]. In complicated and chronic cases, a more extensive procedure called open gallbladder removal is usually necessary.

In individuals who are not able to undergo surgery, a surgeon can perform percutaneous cholecystostomy, which involves a small cut in the abdominal wall, inserting a catheter into the gallbladder and draining its content. This treatment appears to be safe and effective [5,6].

Other treatments include antibiotics and analgesics.

If you have a gallbladder perforation, you can expect to stay in the hospital for about a week [2].

Can gallbladder rupture result in death?

Gallbladder rupture can cause death soon after it occurs or even during its treatment – surgical gallbladder removal. Currently, the reported mortality after gallbladder rupture is 10-16% [2,9].


  1. Gallbladder perforation  Radiopedia
  2. Derici H et al, 2006, Diagnosis and treatment of gallbladder perforation PubMed Central
  3. RS Date et al, 2012, Gallbladder perforation: Case series and systematic review  ScienceDirect
  4. Rustagi T et al, 2011, Ruptured Adenosquamous Cell Carcinoma of the Gallbladder: Case Report and Review of Literature
    PubMed Central
  5. Huang CC et al, 2007, Percutaneous transhepatic gallbladder drainage: a better initial therapeutic choice for patients with gallbladder perforation in the emergency department  PubMed Central
  6. Davis CA et al, 1999, Effective Use of Percutaneous Cholecystostomy in High-Risk Surgical Patients  JAMA Surgery
  7. Sharma A, et al, 2018, Biliary ascariasis presenting with gangrenous perforation of the gallbladder: report of a case and a brief review of literature  PubMed
  8. Kim HJ et al, 2004, A Case of Spontaneous Gallbladder Perforation  PubMed Central
  9. Ausania F et al, 2015, Gallbladder perforation: morbidity, mortality and preoperative risk prediction  PubMed Central
  10. Stefanidis N et al, 2006, Gallbladder perforation: risk factors and outcome  PubMed
  11. Chowksey SR et al, 2014, Diagnosis of Gallbladder Perforation—a Puzzle!  PubMed Central

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