When the Gallbladder is Not the Culprit: Perforated Duodenal Ulcer Presenting as Cholecystitis with Thoracoabdominal Sepsis: A Case Report

Abstract: Acute cholecystitis is a common surgical emergency and may be complicated by abscess formation, as described in the Tokyo Guidelines. However, inflammatory changes in the gallbladder region can occasionally be secondary to adjacent pathology. This is a case of a 63-year-old woman who presented with right upper quadrant pain. Explorations showed an acute cholecystitis with adjacent abscess, a large hepato-phrenic abscess, and massive right pleural empyema. She underwent cholecystectomy and drainage. The postoperative course was marked by air and enteric fluid in the drain. Re-exploration revealed a perforated duodenal ulcer, which was sutured and protected with a jejunostomy. This highlights the importance of searching for a secondary aetiology if the abscess is far from the peri vesicular bed, and the importance of early re-intervention in persistent abnormal postoperative drain output.