TY - JOUR
AR - SCR-2020-12-110
TI - Multidisciplinary Approach to Acute Cholecystitis in a Severely Cardiopathic Patient: Case Report and Review of Literature on Treatment Strategies
AU - Desiree , Pantalone
AU - Giovanni , Alemanno
AU - PierLuigi , Stefano
AU - Stefano , Del Pace
AU - Stefano , Romagnoli
AU - Paolo , Boninsegni
AU - Carlo , Rostagno
AU - Massimo , Bonacchi
AU - Gherardo , Maltinti
AU - Alessandro , Bruscino
AU - Carlo , Bergamini
AU - Jacopo , Martellucci
AU - Luca , Talamucci
AU - Francesco , Mondaini
AU - Claudia , Ranalli
AU - Paolo , Prosperi
JO - Surgical Case Reports
PY - 2020
DA - Fri 11, Dec 2020
SN - 2613-5965
DO - http://dx.doi.org/10.31487/j.SCR.2020.12.10
UR - https://www.sciencerepository.org/multidisciplinary-approach-to-acute-cholecystitis-in-a-severely-cardiopathic-patient_SCR-2020-12-110 
KW -  St Jude ring, acute calculous cholecystitis, myocardial infarction, interventricular septum rupture, Kay procedure, CABG, cholecystectomy, percutanous cholecystostomy, choledochus stones, ERCP
AB - 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.