ALTHOUGH gangrene of the gallbladder is infrequent, it is one of the more serious complications of cholecystitis, carrying with it a mortality of 8.7% to 42.4%.1 Gangrene with perforation occurs in approximately 8% to 12% of all cases of acute cholecystitis.2 Gangrene may occur in any area of the gallbladder where the blood supply becomes compromised and ischemic necrosis develops. With necrosis, perforation generally occurs in one of three ways: (1) into the free peritoneal cavity, (2) into a walled-off pericholecystic abscess, or (3) into an adjacent hollow viscus.3 Of the above complications, pericholecystic abscess is seen much more commonly than the others.
There have been several cases of pericholecystic abscess of such magnitude that the diagnosis of these has mimicked tumors. Peskoe et al4 reported a case where the antrum was obstructed and the large subhepatic abscess mimicked an antral neoplasm. Kravetz and Gilmore