Biliary peritonitis due to bile leakage through the gallbladder without perforation, complicated by carcinoma In situ of the gallbladder: Report of a case

We report a case of biliary peritonitis due to bile leakage from the gallbladder without perforation, complicated by early-stage gallbladder cancer. A 76-year-old man was admitted to our hospital because of severe abdominal pain. Abdominal CT and MRI showed swelling of the gallbladder and the presence of ascites around the liver and the spleen. A laparoscopic operation was performed under a diagnosis of acute cholecystitis. Biliary ascites was found throughout abdominal cavity. No perforation of both the gallbladder and the biliary tract was detectable. Cholecystectomy and peritoneal drainage were performed. Intraoperative cholangiography indicated possibility of pancreaticobiliary maljunction. Histopathological examination revealed severe dysplasia/carcinoma in situ in the body and fundus of the gallbadder. Severe dysplasia extended to subserous layer through Rokitansky-Aschoff sinus (RAS). The thinning of the gallbladder, caused by infiltration of severe dysplasia and carcinoma in situ to RAS and tissue damage by regurgitated pancreatic juice in the presence of occult pancreatobiliary reflux, was followed by bile leakage.