Successful Cystic Duct Stenting in a patient with Gallbladder Perforation and septic shock with Advanced Cirrhosis and Ascites: A Case Report

Abstract Gall bladder (GB) perforation and sepsis are common yet critical conditions frequently encountered in clinical practice. Acute cholecystitis, whether calculus or a calculous, can lead to GB perforation in 6–12% of cases.¹ The mortality rate of Gall Bladder perforation (GBP) has been reported to be between 12% and 16%.² Invasive surgical procedures present significant challenges, especially in patients with advanced liver disease. In particular, those with Child-Turcotte-Pugh (CTP) Class C cirrhosis face a high mortality rate ranging from 17% to 25% following cholecystectomy for acute cholecystitis. For these high-risk patients, less invasive alternatives such as percutaneous cholecystostomy or endoscopic placement of a lumen-apposing metal stent (LAMS) between the GB and gastrointestinal lumen are generally preferred due to their relatively greater safety profile.³ This case report describes a 55-year-old male with CTP-C cirrhosis and ascites who presented with GBP, peritonitis, and septic shock. Given his critical condition and the presence of ascites, Spy Glass cholangioscopy (SPY)-guided cystic duct stenting and gallbladder drainage were performed as a minimally invasive approach, followed by elective surgery once stabilized. The patient recovered well without significant complications. Although not the first reported case, such SPY-assisted cystic duct stenting for biliary drainage in a cirrhotic patient with ascites and septic shock due to GBP remains a rare and noteworthy therapeutic option in complex clinical scenarios where conventional surgical or percutaneous interventions carry high risks.