Unique presentation of perforated gallbladder and gangrene in third trimester pregnancy: management and other considerations

Acute cholecystitis during pregnancy presents significant risks, requiring careful management to balance maternal and fetal health. Conflicting viewpoints exist on conservative versus surgical treatment, particularly in the third trimester. Here, we present a case of a woman in her early 40s at 34 weeks of gestational age with acute cholecystitis and signs of preterm labour. Despite conservative management, she developed sepsis, necessitating a subtotal cholecystectomy due to gallbladder perforation and chronic inflammation. Postoperatively, a cystic duct bile leak was managed with endoscopic retrograde cholangiopancreatography. She was discharged on postoperative day 4 and later had an uncomplicated term vaginal delivery. This case underscores the importance of individualised treatment plans and supports the safety of laparoscopic cholecystectomy during the third trimester. Enhanced research and multidisciplinary provider education are crucial for improving patient decision-making regarding surgical intervention during pregnancy.