A case of gallbladder perforation without cholecystitis or trauma is described herein. The patient was a 74-year-old woman who initially presented with right lower quadrant pain of the abdomen. A laparotomy was performed with the impression of an acute appendicitis at a local clinic. However, the appendix was normal and a large amount of bile was noted in the peritoneal cavity. The patient was referred to our hospital. An exploratory laparotomy was performed with the suspicion of a hollow viscous perforation. A pin point perforation of the gallbladder fundus was identified. There were no gallstones or definite inflammation of the gallbladder wall. Although gallbladder perforation without cholecystitis or trauma is rare, gallbladder perforation without cholecystitis should be considered in elderly patients with bile peritonitis of unknown etiology.