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 .
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
The gallbladder can rupture soon after the onset of gallbladder disease or days to weeks later . 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) 
- Acute cholecystitis without gallstones (in 10-20% cases) 
- 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) 
- Gallbladder cancer (rare) 
- A blunt injury (rare) 
- Ascariasis, caused by parasitic worms (rare) 
Risk factors for gallbladder rupture include [1,2,10]:
- Delayed treatment of cholecystitis
- Old age
- Coronary heart disease
- Diabetes mellitus
- Impaired immunity, such as in HIV/AIDS or immunosuppression therapy
Gallbladder rupture can lead to one or more life-threatening complications :
- 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
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 .
A surgeon can treat acute gallbladder rupture by a minimally invasive laparoscopic gallbladder removal . 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 .
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].
- Gallbladder perforation Radiopedia
- Derici H et al, 2006, Diagnosis and treatment of gallbladder perforation PubMed Central
- RS Date et al, 2012, Gallbladder perforation: Case series and systematic review ScienceDirect
- Rustagi T et al, 2011, Ruptured Adenosquamous Cell Carcinoma of the Gallbladder: Case Report and Review of Literature
- 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
- Davis CA et al, 1999, Effective Use of Percutaneous Cholecystostomy in High-Risk Surgical Patients JAMA Surgery
- 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
- Kim HJ et al, 2004, A Case of Spontaneous Gallbladder Perforation PubMed Central
- Ausania F et al, 2015, Gallbladder perforation: morbidity, mortality and preoperative risk prediction PubMed Central
- Stefanidis N et al, 2006, Gallbladder perforation: risk factors and outcome PubMed
- Chowksey SR et al, 2014, Diagnosis of Gallbladder Perforation—a Puzzle! PubMed Central