The gallbladder is a small, pear-shaped organ located beneath the liver in the upper right section of the abdomen. Its primary function is to store and concentrate bile, a digestive fluid produced by the liver, before releasing it into the small intestine to help break down fats. Although it is a relatively small organ, complications can be extremely serious. The answer to whether your gallbladder can burst is a definitive yes. This severe event is medically termed gallbladder perforation or rupture, and it represents an advanced stage of disease that demands immediate emergency intervention.
The Path to Perforation
The process that leads to a gallbladder rupture typically begins with acute cholecystitis, which is sudden and severe inflammation of the gallbladder wall. This inflammation is most frequently caused by a gallstone becoming lodged in the cystic duct, the channel that drains bile from the gallbladder. The blockage prevents bile from leaving the organ, causing it to back up and dramatically increase internal pressure.
This sustained internal pressure causes the gallbladder wall to become severely distended and swollen. The swelling ultimately compresses the blood vessels supplying the wall, leading to impaired blood flow, a condition known as ischemia. Without an adequate blood supply, the gallbladder tissue begins to die, a process called necrosis.
The necrotic, weakened tissue eventually tears or develops a hole, resulting in perforation. The most common site for this tear is the fundus, the rounded, distal end of the gallbladder, as this area often has the poorest blood supply. When the wall breaches, the highly irritating and often infected bile, pus, and sometimes gallstones spill directly into the abdominal cavity, leading to a life-threatening infection. Perforation can occur anywhere from two days to several weeks after the initial onset of acute cholecystitis symptoms.
Emergency Signs and Symptoms
A rupture is marked by a sudden, dramatic worsening of the patient’s condition, moving beyond the pain of standard gallbladder inflammation. The immediate release of bile and bacteria into the abdomen causes a severe infection and inflammation of the abdominal lining, known as generalized peritonitis. This peritonitis is the reason for the intense, spreading pain that marks a true emergency.
The pain, which may have been localized to the upper right abdomen, becomes sudden, widespread, and excruciating. It is often accompanied by the abdomen becoming rigid or board-like to the touch. Other systemic signs of infection will quickly emerge, including a high fever and chills. The patient may also experience a rapid heart rate (tachycardia) as the body attempts to compensate for the overwhelming infection and potential septic shock.
Any combination of these signs, particularly a sudden shift from localized pain to generalized, severe abdominal distress, requires immediate emergency medical attention. Confusion or a significant drop in blood pressure are late-stage signs indicating the infection has progressed to sepsis, where the body’s response begins to injure its own tissues and organs. Early diagnosis is complicated because initial symptoms of perforation can sometimes mimic those of uncomplicated acute cholecystitis.
Critical Care and Surgical Intervention
Once a ruptured gallbladder is suspected or confirmed, the immediate focus in the hospital is patient stabilization to combat the widespread infection and fluid loss. This involves administering broad-spectrum intravenous (IV) antibiotics to fight the bacteria that have spilled into the abdomen. Large volumes of IV fluids are also given to correct dehydration and stabilize blood pressure, especially if the patient is showing signs of shock.
To definitively confirm the diagnosis and determine the extent of the damage, rapid diagnostic imaging is performed, typically starting with an abdominal ultrasound or a Computed Tomography (CT) scan. The CT scan is often superior for identifying a defect in the gallbladder wall and revealing pericholecystic fluid, which is evidence of leaked bile and pus. The definitive treatment for a perforated gallbladder is an emergency cholecystectomy, the surgical removal of the diseased organ.
The surgeon must thoroughly clean the abdominal cavity after removing the perforated gallbladder. This cleansing procedure, called peritoneal lavage, washes out the spilled bile, pus, and debris to prevent further infection. In some cases, a small, contained rupture may be initially treated with a percutaneous cholecystostomy, where a drainage tube is inserted through the skin to relieve pressure and drain the infected contents, followed by eventual surgery once the patient is stable. Due to the severity of the infection, an emergency cholecystectomy carries a higher risk of complications and a longer recovery period compared to a planned procedure.