Ultrasound diagnosis of gallbladder perforation in a case of xanthogranulomatous cholecystitis

Cholelithiasis is a common disease and perforation and carcinoma of the gallbladder are well recognized complications. Xanthogranulomatous cholecystitis is an uncommon form of cholecystitis which is being recognized with increasing frequency. We report a case in which gallbladder perforation was diagnosed by ultrasound in a patient in whom all four conditions coexisted. A 73-year-old woman presented with a 1-month history of rapidly worsening dementia following an episode of abdominal pain. Nine days before admission to hospital an abdominal swelling had been noticed. On examination she was pyrexial with a neutrophilia; there was a large, tender, fluctuant epigastric mass, pointing through erythematous skin.