O/E: Afebrile, abd- mild distention, IPS-absent or very sluggish...severely tender rt hypochondrium with muscle guarding and a tender lump continuous with the liver edge. USG: liver, GB, CBD normal & dilated gut loop at RIF abd X-ray: dilated ascending colon and splendid flexure decision taken to open the abdomen despite USG and X-ray not much suggestive To my surprise what I saw was a perforated gangrenous GB as shown below...
No GB stone was there Only wall thickening (Ca--not much sure) of GB at neck Please enlighten me regarding the following queries: What are the causes of GB perforation without stone disease? Any proceeding clues or history from where I can suspect it What else I need to note/see during laparotomy in this particular case?
