{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T12:00:57Z","timestamp":1756382457146,"version":"3.40.4"},"reference-count":17,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,7,2]]},"abstract":"<jats:p>Perforation of the gall bladder can occur due to a complication of acute (in 3%\u201310%) or chronic cholecystitis, presenting with or without gallstones. Other causes include trauma, neoplasms, steroid therapy or vascular compromise. In 1934, Niemeier classified the condition into three types: type I, acute perforation into the free peritoneal cavity; type II, subacute perforation with abscess formation; and type III, chronic perforation with fistula formation between the gall bladder and another viscus with type I experiencing the highest mortality rate. In particular, there are very few cases of gall bladder perforation associated with ischaemic bowel disease. We present a case of type I gall bladder perforation in a 70-year-old woman, without any apparent comorbidities, presenting with acute abdomen consistent with perforated duodenal ulcer with pneumoperitoneum on a plain abdominal radiograph and contrast-enhanced CT with eventual discovery of fundal perforation and ischaemic small bowel at laparotomy.<\/jats:p>","DOI":"10.1136\/bcr-2018-224883","type":"journal-article","created":{"date-parts":[[2018,7,17]],"date-time":"2018-07-17T13:04:37Z","timestamp":1531832677000},"page":"bcr-2018-224883","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Spontaneous gall bladder perforation with ischaemic bowel disease: a rare cause of acute abdomen with pneumoperitoneum in elderly"],"prefix":"10.1136","volume":"2018","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4302-5921","authenticated-orcid":false,"given":"Nikita","family":"Wadhwani","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omesh Kumar","family":"Meena","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivek","family":"Verma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,7,17]]},"reference":[{"key":"2025042705340398000_2018.jul17_1.bcr-2018-224883.1","first-page":"152","article-title":"Ischemic gallbladder 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