Gallbladder perforation presenting with hemorrhagic shock: Two case reports and an approach to management

Gallbladder perforation is an uncommon surgical condition usually secondary to severe acute cholecystitis. In this report we present a comparison of management for two comorbid patients with gallbladder perforation who presented atypically with hemorrhagic shock, symptomatic large volume hemoperitoneum, and did not have evidence of acute cholecystitis. One patient had a clearly identified gallbladder wall perforation on initial imaging with hemodynamic instability and underwent urgent laparotomy and cholecystectomy. The other patient did not have a clearly identified source for the hemoperitoneum and was later found to have a biliary leak through a HIDA scan. He was a poor surgical candidate due to extensive co-morbidities and was stabilized with resuscitative measures. He was managed conservatively for several days before he clinically deteriorated and passed away. Both patients had different outcomes based on their underlying co-morbidities, presentations and treatment plans.