The gallbladder is a small, pear-shaped organ situated beneath the liver in the upper right side of the abdomen. Its primary function is to store and concentrate bile, a fluid produced by the liver that aids in fat digestion. It releases this bile into the small bowel when food is consumed. A gallbladder rupture, or perforation, occurs when the wall of this organ tears, allowing bile and potentially infected material to leak out into the abdominal cavity. This serious, life-threatening medical emergency requires immediate intervention, as the leakage can quickly lead to widespread infection and systemic collapse.
Recognizing the Emergency Signs
Distinguishing a standard gallbladder attack (biliary colic) from a rupture involves recognizing a progression in the severity and spread of symptoms. A typical attack involves severe pain localized to the upper right quadrant of the abdomen, often radiating to the right shoulder blade. A rupture causes a sudden, dramatic worsening of this pain, which becomes more generalized as the irritating fluids spread throughout the abdominal cavity.
The leakage of bile and bacteria causes severe infection and inflammation of the abdominal cavity lining, a condition called peritonitis. This results in specific physical signs, including an abdomen that feels rigid or “board-like” upon touch. Another indicator is rebound tenderness, which is a sharp pain felt when pressure is quickly released from the abdomen.
A high fever, often spiking rapidly, is a common response as the body attempts to fight the infection. This fever is usually accompanied by chills and an elevated heart rate (tachycardia), as the body struggles to maintain blood pressure and oxygen delivery. Nausea and vomiting are also frequently present, as the digestive system is impacted by the systemic infection.
If the infection progresses, it can lead to septic shock, a life-threatening state causing organ dysfunction. Signs of this progression include dangerously low blood pressure and mental changes, such as confusion or disorientation. If the rupture is related to a bile duct blockage, jaundice may develop, characterized by a yellowing of the skin and eyes due to excess bilirubin.
Any person experiencing a combination of sudden, generalized abdominal pain, a rigid abdomen, high fever, or confusion must seek emergency medical care without delay. Prompt action is necessary to prevent the cascading effects of widespread infection and organ failure.
Common Causes and Underlying Conditions
A gallbladder rupture is most often a complication of acute cholecystitis, the sudden inflammation of the gallbladder. This inflammation typically occurs when gallstones, hardened deposits of digestive fluid, block the cystic duct, the tube through which bile leaves the gallbladder. The blockage traps bile, increasing pressure within the organ.
This increased internal pressure compromises blood flow to the gallbladder wall, leading to tissue damage and necrosis (tissue death). When the wall weakens sufficiently, it tears or perforates. This process usually develops over hours or days following the onset of severe, untreated cholecystitis.
Gallstones (cholelithiasis) are the primary predisposing factor for rupture because they initiate the inflammatory and obstructive sequence. Rupture can also occur in cases of acalculous cholecystitis, which is inflammation without gallstones, often seen in critically ill individuals or those with severe underlying conditions.
Direct external trauma to the abdomen, such as from a motor vehicle accident or blunt force injury, is another cause, though it is less common. The underlying mechanism involves a compromise to the integrity of the organ wall, allowing contents to escape.
Emergency Diagnosis and Treatment
Once a rupture is suspected, medical teams move quickly to confirm the diagnosis and stabilize the patient. Initial diagnostic steps involve blood tests to check for signs of infection and systemic stress. An elevated white blood cell count indicates a significant infection, while high levels of inflammatory markers, such as C-reactive protein, further support the diagnosis.
Imaging studies are performed immediately to visualize the abdomen and the gallbladder. Abdominal ultrasound is often the first tool used to look for wall thickening, distension, and fluid surrounding the organ, suggesting leakage. A Computed Tomography (CT) scan provides a detailed view, clearly showing free fluid or air in the abdominal cavity, which confirms perforation.
Stabilization efforts begin concurrently with diagnosis, focusing on combating the severe infection and shock. Intravenous fluids are administered rapidly to manage low blood pressure and restore circulating volume. Broad-spectrum antibiotics are given immediately to target the bacteria that have leaked into the abdominal space.
The definitive treatment is emergency surgery, known as a cholecystectomy. The goal of this procedure is to remove the damaged organ and cleanse the abdominal cavity. Surgeons perform an abdominal lavage, washing out leaked bile and infected material to prevent further peritonitis and sepsis. While a laparoscopic approach is preferred for routine removal, the severe contamination from a rupture may necessitate a traditional open surgery to ensure thorough cleaning.