Clinically Silent Gangrenous Cholecystitis: A Case Report of Two-Week Survival Following Spontaneous Gallbladder Perforation Without Intervention.

Spontaneous gallbladder perforation is an infrequent but life-threatening complication of acute cholecystitis, often associated with rapid clinical deterioration and high mortality. Prompt diagnosis and surgical intervention are critical. Atypical presentations in gallbladder perforation, especially if silent, often delay recognition and treatment, increasing the risk of adverse outcomes. We present the case of a 68-year-old male who presented to the emergency department with generalized weakness. Notably, he reported an episode of severe abdominal pain two weeks prior, which had since resolved. Vital signs and physical exam were normal. Imaging demonstrated pneumobilia and a pericholecystic fluid collection consistent with a contained gallbladder perforation. The patient underwent urgent laparoscopic cholecystectomy, which revealed a mid-body gallbladder perforation with extensive gallstone spillage and purulent drainage. Pathology confirmed gangrenous cholecystitis. He recovered uneventfully following surgery and was discharged on postoperative day seven, with no complications noted at his two-week follow-up. This case illustrates a rare presentation of a type II gallbladder perforation that remained clinically silent for two weeks, without signs of peritonitis or systemic compromise. Clinicians must maintain a high index of suspicion for serious intra-abdominal pathology in elderly patients presenting with vague or atypical symptoms, to ensure timely diagnosis and intervention in cases of gallbladder perforation.