Introduction and importanceVentral gallbladder hernia is a rare condition mostly related to past acquired abdominal wall defects, but spontaneous ones are scarce. It happens more in elderly patients. Etiology and causes are still unspecified, but the most related known causes of spontaneous gallbladder herniation are carcinoma, biliary tracked occlusion or abdominal wall weakness in elderly patients, respectively.Case presentationWe have presented a complicated 90-year-old woman with a bulged and warm area at the right upper abdomen with tenderness and positive rebound tenderness. In help with imaging, we found a ventral gallbladder hernia perforated in the subcutaneous layer. Then cholecystectomy and herniation site repair was performed.Clinical discussionWe have explained this infrequent scenario and reviewed recent similar papers to find further relevant information. The common presentations, probable causes, the role of imaging in diagnosis and the management are discussed for the best surgical planning.ConclusionThe spontaneous ventral herniation of the gallbladder is an exceedingly uncommon occurrence. The diagnosis of this condition heavily relies on imaging, with computed tomography (CT) scan utilizing both intravenous and oral contrast being the optimal modality. Management of this condition can be accomplished via both laparoscopic and laparotomy approaches. It is our recommendation to perform cholecystectomy and hernia repair simultaneously and expeditiously in all cases. We advise against conservative management strategies.