Abstract A 9-year-old girl presented clinically with right-sided congestive heart failure, abdominal distension and jaundice. The patient was diagnosed with a large secundum atrial septal defect and cardiac cirrhosis. One week after surgical atrial septal defect closure, biliary peritonitis due to spontaneous gallbladder perforation was detected. The patient underwent T-tube cholecystostomy. Unfortunately, the patient died from septicemia and cardiac arrest. A delayed diagnosis of the gallbladder perforation was the major cause of mortality in our patient.