Gastric perforation mimicking acute cholecystitis: a case report

Peptic ulcer disease is a common disorder typically presenting with right upper quadrant and epigastric pain. It can result in perforation when not identified and treated in a timely fashion. We report a case of a 71-year-old female who presented with a workup consistent with acute cholecystitis, who was found to have a gastric ulcer perforation intraoperatively when the prepyloric perforated ulcer was found to be adherent to the gallbladder wall. The case was treated via robotic-assisted laparoscopic cholecystectomy. The cholecystectomy was followed by primary closure of the ulcer defect with omental buttress without modifying port placement or converting to an open procedure. Our case exemplifies how different pathologies can present with similar physical exam findings and imaging, particularly in the upper abdomen. Additionally, this case demonstrates the safety and efficiency of adjustments to intraoperative technique permitted by robotic-assisted laparoscopy when confronted with unexpected findings.