2020 Vol.8 No.6:2 Case Report Journal of Universal Surgery ISSN 2254-6758 1 iMedPub Journals www.imedpub.com © Under License of Creative Commons Attribution 3.0 License | This Article is Available in: www.jusurgery.com Ahmed Siddique Ammar*, Zahra Sattar, and Syed Asghar Naqi Surgical Unit-I (EAST Surgical Ward), MAYO Hospital, Lahore, Pakistan. *Corresponding author: Ahmed Siddique Ammar  asammar1912@gmail.com Surgical Unit-I (EAST Surgical Ward), MAYO Hospital, Lahore, Pakistan Tel: 0333998191 Citation: Ammar AS, Satar Z, Naqi SA (2020) A Case Report of Acalculus Gall Bladder Perforaton with Huge Abdominal Cyst. J Univer Surg. Vol.8 No.6:2 Introducton Gallbladder perforaton is a rare presentaton encountered in the surgical emergency foor [1]. The most common mode of presentaton of gall bladder perforaton is peritonits but the pre-operatve diagnosis of gall bladder perforaton is difcult to make especially where there is no availability of advance imaging techniques like CT scan [2]. This delay can result in morbidity and even mortality of the patent with signifcant infuence on the outcomes. The reported incidence of gallbladder perforaton in patents with acute cholecystts is 2–18% while the incidence of gallbladder perforaton because of acalculous cholecystts is about 10 to 20%. The exact mechanism of gall bladder perforaton in patents with acalculous cholecystts is not understood [3]. In some patents of acalculous cholecystts the impacted stone in the cystc duct fall back into gallbladder and this resolves the cholecystts while if this infammaton don’t get resolved then persistent infammaton causes the development of empyema which inurn leads to necrosis and eventually perforaton [4]. In most of the cases where perforaton occurs at fundus, omentum is least likely to cover the perforaton so gross peritonits occurs. On the other hand, if perforaton occurs at neck or the duct it is most commonly get sealed by omentum or the intestnes which results in either local infammaton. The duraton of symptoms may extend from one week to several months [5]. In this case report, we present a case report of 19-year female presented to surgical emergency department with sign and symptoms of huge intra-abdominal cyst. The patent had history A Case Report of Acalculus Gall Bladder Perforaton with Huge Abdominal Cyst Received: November 16, 2020; Accepted: December 07, 2020; Published: December 14, 2020 Abstract Background: Gallbladder perforaton present in various forms with most common is the peritonits. Most common causes include gallstones obstructng the cystc duct and necrosis of gall bladder due to ischemia. Case presentaton: 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 examinaton, 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 negatve for malignant cells and total leukocyte count of 17 × 10 9 /l. Abdominal ultrasound showed a huge thick- walled cystc area with internal echoes measuring 31 cm × 19 cm × 19 cm with total amount of fuid 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 fuid aspirated. Communicaton between cysts was found with gall bladder inn the epigastrium. Cyst wall was excised partally and cholecystectomy done. Patent was discharged on 5th post-operatve day. Conclusion: The development of thick-walled huge cyst within abdominal cavity afer gall bladder perforaton is a rare entty especially when patent had gone through full term pregnancy in the presence of cyst. Keywords: Gall bladder; Perforaton; Cyst; Pregnancy; Fistula