Gallbladder perforation in pregnancy.

Gallbladder perforation is an infrequent but potentially fatal disease. It is extremely rare during pregnancy. We report two cases of gallbladder rupture in the immediate postpartum period and review the literature. The first patient was a 28-year-old polysubstance abuser who presented at 29 weeks' gestation with generalized abdominal pain and ascites. Over a 48-hour period, her abdominal pain increased, and preterm labor and delivery occurred. She had an exploratory laparotomy the day after delivery for persistent abdominal pain and ascites, and a ruptured, gangrenous gallbladder was found. This patient died secondary to complications of the disease. Our second patient had a history of cholelithiasis and developed abdominal pain on the third postpartum day. Three days later, she was taken for exploratory laporatomy and was found to have a ruptured gallbladder. She did well postoperatively. The signs and symptoms of a ruptured gallbladder can be quite confusing in pregnancy. Ultrasonography, ascitic fluid analysis, computed tomography, and magnetic resonance imaging are useful adjuncts in diagnosis. A high index of suspicion, prompt recognition, and early surgical intervention are the mainstays of therapy.