Case report:
The patient was an 80-year-old woman who had been describing recurrent hepatic colic for 5 years prior to her present consultation. She consulted for right hypochondrial pain accompanied by chills. At the examination she exhibited fever of 38.7°c, accelerated pulse to 114 bpm, guarding circumscribed to the right hypochondrium with tenderness on the remaining quadrants, without icterus. On biology, inflammatory markers were increased without cholestasis. On ultrasound, the gallbladder was thickened and 5 mm in size, with lithiasis and subhepatic and Douglas effusion. After adequate resuscitation, patient was rushed for exploratory laparotomy for a cholecystectomy for acute perforated cholecystitis. The surgical approach involved a right subcutaneous incision. The inspection revealed a generalized purulent effusion with denses adhesions in hepatic area rendering the dissection hazardous. A slit on the left side allowed to widen the operative incision. After adhesiolysis and thorough washout of encountered intraperitoneal spillage, we have identified an inflammatory intestinal-mesenteric organization compartmentalizing a punctiform perforation at the antemesenteric edge with sphaceous edges, oedematous intestinal wall around the perforation and mesenteric engorgement. The bidigital palpation found a mass that rolled over the fingers. She had a segmental resection with transformation into a double ileostomy accompanied by feeding jejunostomy, in the perspective of overcoming disorders associated with a proximal ilesotomy, due to perforation located at 40cm of the ligament of Treiz. A gallstone measuring 2cm was expressed out from the specimen. Her postoperative progress was almost uneventful; however, several days were required for wound healing and improvements in daily living activities because she was frail and elderly. Histopathological results of the intervened patient revealed isolated jejunal perforation with ischemic edges and covered with fibrous coating, without local inflammatory process or arteriosclerosis at the site of perforation. There was no evidence of malignancy in the resected specimen. She later passed away 2 months later due to major ionic disorders.