Gallbladder Perforation in a Pregnant Patient: A Case Report and Considerations of Surgical Approach.

Gallbladder disease is a frequent indication for non-obstetric surgical intervention during pregnancy. Gallbladder perforation (GBP) during pregnancy is an uncommon but severe pathology that usually requires immediate attention, and it represents a challenge for surgeons. We present the case of a GBP in a pregnant patient alongside a discussion of available surgical approaches. A 32-year-old pregnant patient at 21.5 weeks of gestation presented with a four-day history of abdominal pain. Two weeks prior, she underwent an endoscopic retrograde cholangiopancreatography (ERCP) for stone removal and biliary and pancreatic prostheses placement due to choledocholithiasis. The patient was admitted for a follow-up ERCP with lithotripsy. A laparoscopic total cholecystectomy was indicated, during which abundant purulent secretion, four stones in the abdominal cavity, and the transverse colon in close contact with the gallbladder were identified. A critical view of safety was obtained, and type 2B subtotal cholecystectomy was performed, with abscess drainage and Blake drainage placed. Postoperative follow-up and gestation were uneventful. Although uncommon, GBP in pregnancy should always be considered in patients with a history of gallbladder symptomatology. An early diagnosis allows for an opportune surgical approach, which should not be delayed. This allows for the best outcomes in pregnancy for both the fetus and the gestational parent.