Laparoscopic management of intra-hepatic gallbladder perforation

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Surgical Complications
• Abdominal Imaging

Background:

• Intra-hepatic perforation of the gallbladder (GB) is a rare and severe complication of cholecystitis.
• Limited case reports exist, lacking a standardized treatment protocol.
• This condition necessitates comprehensive radiological assessment prior to surgical intervention.

Observation:

• A thorough evaluation using computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) is crucial.
• Surgical intervention is required for definitive management.
• Previous literature has suggested open surgery as the primary approach.

Findings:

• Early laparoscopic intervention, involving sub-total cholecystectomy and drain placement, effectively treats both cholecystitis and hepatic abscess.
• This minimally invasive approach addresses the acute condition definitively.
• Our case series supports laparoscopic management as a safe and suitable option.

Implications:

• Laparoscopic sub-total cholecystectomy represents a viable and potentially superior alternative to open surgery for intra-hepatic GB perforation with hepatic abscess.
• This approach may lead to reduced patient morbidity and faster recovery.
• Further research and case studies can help solidify laparoscopic management as the standard of care.