BACKGROUND: Gallstone disease is common, and complications that are frequently encountered include acute cholecystitis and acute pancreatitis, but rarely gallbladder perforation.
METHOD: Data were retrospectively collected from clinical case notes and a literature review is presented.
RESULTS: A 72-year-old lady presented with spontaneous gallbladder perforation, pericholecystic abscess and cholecystoduodenal fistula as the first manifestations of gallstone disease. She was previously well and had no abdominal complaints. Her condition was successfully managed with initial antibiotic therapy followed by interval cholecystectomy and fistula repair.
CONCLUSIONS: Our case highlighted some uncommon but severe complications which occurred simultaneously as the first manifestations of previously asymptomatic gallstone disease. Such complications need to be considered in patients suspected of intra-abdominal sepsis, even when there are no characteristic symptoms.