Multidisciplinary Approach to Acute Cholecystitis in a Severely Cardiopathic Patient: Case Report and Review of Literature on Treatment Strategies
Desiree Pantalone Giovanni Alemanno PierLuigi Stefano Stefano Del Pace Stefano Romagnoli Paolo Boninsegni Carlo Rostagno Massimo Bonacchi Gherardo Maltinti Alessandro Bruscino Carlo Bergamini Jacopo Martellucci Luca Talamucci Francesco Mondaini Claudia Ranalli Paolo Prosperi
Corresponding AuthorDesiree Pantalone
Fellow of the American College of Surgeons, Assistant Professor in General Surgery, Department of Experimental and Clinical Medicine, University of Florence, Specialist in Vascular Surgery, Emergency Surgery Unit, Trauma Team, Emergency Department, Careggi University Hospital, Florence, Italy
A B S T R A C T
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.
Article TypeCase Report and Review of the Literature
Publication historyReceived: Fri 13, Nov 2020
Accepted: Thu 26, Nov 2020
Published: Fri 11, Dec 2020
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