Multidisciplinary Approach to Acute Cholecystitis in a Severely Cardiopathic Patient: Case Report and Review of Literature on Treatment Strategies
2020
Acute cholecystitis in severely cardiopathic patients after major cardiac surgery represents a challenge for
surgeons. Treatment with cholecystostomy, may offer a chance to these patients, however there is still a
number of controversial issues on the topic: performance surgical techniques (transhepatic or
transpapillary), optimal duration and timing of drain removal, the need for further tests before removal as
well as the timing for definitive surgery. We therefore deemed it important to share our experience of a
multidisciplinary approach for the definitive treatment of this patient with severe heart disease. A
percutaneous cholecystostomy was the chosen strategy for a 58-year-old cardiopathic patient who had
undergone surgery for hip replacement and had developed acute calculous cholecystitis a few days after
surgery. Two weeks after discharge, a cholangiography through the cholecystostomy and an MRI
cholangiopancreatography revealed the presence of stones in the cystic duct and in the ductus choledochus.
The definitive treatment was decided after consulting with a multidisciplinary team. The choice was to
perform an open cholecystectomy with simultaneous removal of the cholecystostomy, endoscopic removal
of stones and sphincterotomy of the Oddi papilla. Currently, the patient is healthy and his heart function
satisfactory. Although early cholecystectomy is the recommended choice for acute cholecystitis, a patient
with severe co-morbidities may benefit from a bridging therapy before definitive surgery and a
multidisciplinary approach can provide a safer solution.
Keywords:
- Correction
- Source
- Cite
- Save
- Machine Reading By IdeaReader
0
References
0
Citations
NaN
KQI