Ahmed Siddique Ammar, Zahra Sattar, and Syed Asghar Naqi
Background: Gallbladder perforation present in various forms with most common is the peritonitis. Most common causes include gallstones obstructing the cystic duct and necrosis of gall bladder due to ischemia.
Case presentation: A 19-year-old female presented in the emergency department of EAST Surgical Ward of MAYO Hospital Lahore, Pakistan with history of abdominal distension for 4 months for which she was counseled to be because of pregnancy. She gave birth to healthy baby one month back but abdominal distension didn’t resolve. On examination, she had distended and tender abdomen with visible striae. She was tachycardiac with pulse of 124 per minute and blood pressure of 110/80 mmHg. Fluid cytology showed negative for malignant cells and total leukocyte count of 17 × 109/l. Abdominal ultrasound showed a huge thickwalled cystic area with internal echoes measuring 31 cm × 19 cm × 19 cm with total amount of fluid volume in the cyst was approximately 5 liters arising from right hypochondrium. On opening the abdomen, a huge cyst was encountered extending from epigastrium to pelvis with dense adhesions. Cyst was opened and fluid aspirated. Communication between cysts was found with gall bladder inn the epigastrium. Cyst wall was excised partially and cholecystectomy done. Patient was discharged on 5th post-operative day.
Conclusion: The development of thick-walled huge cyst within abdominal cavity after gall bladder perforation is a rare entity especially when patient had gone through full term pregnancy in the presence of cystt.
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