# Post-cholecystectomy Choleperitoneum Due to Cystic Duct Stump Leak: A Case Report Emphasizing Diagnostic Challenges and Multidisciplinary Management

## TL;DR

A rare case of biliary peritonitis after gallbladder surgery highlights the importance of early detection and multidisciplinary care to prevent severe complications.

## Contribution

This case report emphasizes the diagnostic challenges and management strategies for post-cholecystectomy choleperitoneum.

## Key findings

- Biliary peritonitis can present with non-specific symptoms and subtle imaging findings, leading to delayed diagnosis.
- Multidisciplinary management including ERCP and antibiotics improved the patient's condition.
- Early recognition and intervention are crucial to prevent life-threatening complications.

## Abstract

Biliary peritonitis, also known as choleperitoneum, is a rare but severe complication of cholecystectomy. The symptoms are non-specific, which can cause a delay in the diagnosis, leading to potential sepsis and multi-organ failure. A 45-year-old female underwent robotic cholecystectomy for gallstone pancreatitis and cholecystitis. One week post-operatively, she presented again with abdominal pain and distention, rapidly progressing to septic shock with respiratory, renal, and neurological failure. Initial imaging showed only mild ascites. Imaging showed a biliary leak, and paracentesis confirmed a biliary peritonitis by revealing bilious fluid (ascitic bilirubin 25 mg/dL). The patient underwent endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent placement and was started on antibiotics, with improvement in clinical condition. The case highlights the diagnostic difficulty of choleperitoneum, where early imaging can be subtle. Timely, multidisciplinary management involving peritoneal drainage, ERCP with stent placement, and prophylactic antibiotics is necessary; otherwise, biliary peritonitis is associated with significant mortality and morbidity. This report underscores the need for vigilance even after technically uneventful surgery, particularly in high-risk patients.