Abstract
Spontaneous perforations of the biliary tract are rare in adults and even more so during pregnancy. Perforation of the gall bladder is a potentially fatal complication of cholecystitis. The infrequency of perforation in the setting of calculous disease of the gall bladder is probably due to the thickened wall of the organ that has long been the seat of chronic inflammation. Common bile duct perforations have been reported in adults most commonly in association with choledocholithiasis. The diagnosis of biliary tract perforations is often delayed due to their non specific symptoms, which results in high morbidity. Early diagnosis and aggressive therapy are mandatory to alleviate this condition. Delayed diagnoses and treatment may have more serious consequences for pregnant women than for other patients. Very few cases of biliary tract perforations have been reported in pregnant women. We report two such cases in pregnancy: first of a gall bladder perforation associated with cholelithiasis and the second of a common bile duct perforation in pregnancy in which no apparent cause was found.
Highlights
The incidence of biliary tract disease during pregnancy ranges from 0.05% to 0.3% [1]
Gall bladder perforation has been reported to occur in 3 to 10% cases of acute cholecystitis in adults; it has rarely been reported in pregnancy [4]
Gall bladder or CBD perforations as a cause of peritonitis in pregnancy have been rarely reported in literature and their exact incidence in pregnancy is not known
Summary
The incidence of biliary tract disease during pregnancy ranges from 0.05% to 0.3% [1]. Gall bladder perforation has been reported to occur in 3 to 10% cases of acute cholecystitis in adults; it has rarely been reported in pregnancy [4]. Risk factors for gall bladder perforation in adults include: age greater than 60 years, immunosupression, steroid use, and severe systemic disease [4] Since this condition is unusual during pregnancy, accurate diagnosis and treatment may be delayed resulting in perinatal morbidity. A clinical diagnosis of peritonitis due to bowel perforation was made and the patient underwent an exploratory laparotomy, which revealed about 4 litres of purulent fluid inside the peritoneal cavity. Histopathology of the gall bladder was suggestive of acute cholecystitis Her pregnancy continued and at 37 weeks' gestation she vaginally delivered a healthy baby. The mother and child are doing well after a follow up period of one year
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