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She was started on intravenous antibiotics, presumably treating an episode of acute cholecystitis, but an initial ultrasound (US) done at the long-term care hospital revealed a normal examination. The patient improved initially, but her symptoms recurred after 2 weeks, and she was transferred to the main hospital for further management. An abdominal CT scan revealed signs of acute acalculous cholecystitis, but magnetic resonance cholangiopancreatography (MRCP) performed a few days after confirmed acute calculous cholecystitis complicated by a type II gallbladder perforation.<\/jats:p>","DOI":"10.1136\/bcr-2025-266478","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T00:00:27Z","timestamp":1751587227000},"page":"e266478","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Complex presentation of acute cholecystitis in a long-term care resident"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6876-2532","authenticated-orcid":false,"given":"Zane","family":"Attard","sequence":"first","affiliation":[{"name":"Medicine, Mater Dei Hospital, Msida, 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