A Sealed-Off Gallbladder Perforation with Cholelithiasis and Underlying Adenocarcinoma: A Rare Case Report

Gallbladder perforation (GBP) is an uncommon but potentially life-threatening complication of acute cholecystitis. It typically occurs due to delayed diagnosis and is associated with high morbidity and mortality. In elderly patients, clinical presentation may be atypical, and in rare instances, GBP may unmask an underlying gallbladder carcinoma. We present the case of a 70-year-old hypertensive female who presented with right upper quadrant abdominal pain and low-grade fever. Imaging with contrast-enhanced computed tomography (CECT) revealed a sealed-off gallbladder perforation, a suspicious soft tissue mass in the gallbladder fundus, and multiple gallstones. She underwent a radical cholecystectomy with liver wedge resection and regional lymphadenectomy. Histopathological examination confirmed moderately differentiated gallbladder adenocarcinoma infiltrating the perimuscular connective tissue, with no serosal involvement and negative lymph nodes. The final staging was pT2aN0M0 (Stage II). This case highlights the need to maintain a high index of suspicion for malignancy in elderly patients presenting with complicated cholecystitis and underscores the importance of early surgical intervention in improving outcomes.