PERFORATION of the gallbladder is a rare complication of gallbladder disease. In 1943 Cowley and Harkins1 collected 12,915 operations on the gallbladder reported in the literature and found that perforation had occurred in 433, an incidence of perforation of 2.8%. The experience at this clinic, recently reported by Fletcher and Ravdin,2 is similar, with 44 instances of perforation in 2,807 gallbladder operations, an incidence of 1.6%.
Niemeier3 has classified gallbladder perforations into the following three groups: Group I, chronic perforations with a fistulous communication between the gallbladder and some other viscus; Group II, subacute perforations with the formation of a pericholecystic abscess, walled off by adhesions from the general peritoneal cavity, and Group III, acute perforations into the free peritoneal cavity. Fletcher and Ravdin2 applying this classification to several reported series of perforations, found the average incidence of the three groups to be as follows: Group