Carbon dioxide (CO2) Cholangiography in Diagnosis of Gallbladder Perforation, Black and White

Gallbladder perforation is a rare and serious complication of acute cholecystitis that requires prompt diagnosis and treatment. Current imaging techniques, such as the use of iodinated contrast agents, have limitations in certain patient populations. Carbon dioxide (CO2) contrast media has emerged as a potential alternative due to its non-nephrotoxic and non-allergenic properties. However, there is limited research on the use of CO2 cholangiography for assessing gallbladder perforation. In this case presentation, we describe the use of CO2 cholangiography in a 72-year-old woman with suspected acute cholecystitis and gallbladder perforation. The patient underwent percutaneous cholecystostomy due to her unsuitable general condition for surgery. CO2 cholangiography revealed loss of biliary tract integrity and obstruction of the cystic canal. CO2 cholangiography offers the advantages of decreased cholangitis risk and improved patient comfort. Although this case demonstrates the feasibility of CO2 cholangiography for gallbladder perforation assessment, further studies are needed to validate the safety and efficacy of this technique. Overall, CO2 contrast media may provide high-quality imaging with a lower risk of complications, highlighting the potential benefits of its use in percutaneous interventions for biliary leakage evaluation.