Hepatobiliary and gallium imaging findings in gallbladder perforation: a case report and review of the literature.

Gallbladder perforation is an unusual condition with a high mortality rate. Early detection with prompt surgical intervention can increase the survival rate. Hepatobiliary imaging using Technetium-99m-labeled iminodiacetic acid has been used for the diagnosis of gallbladder perforation. However, the results vary and are somewhat confusing. The authors report a case of gallbladder perforation with hepatobiliary imaging and an unusual gallium image; review the literature; and propose a classification of three different imaging patterns: 1) visualization of the gallbladder with bile leakage, 2) nonvisualization of the gallbladder with a photopenic fluid collection, and 3) nonvisualization of the gallbladder with bile leakage. These patterns may provide pathophysiologic information for surgeon.