A Case Report of Sepsis Secondary to Perforated Cholecystitis in the Presence of Severe Aortic Stenosis: Diagnosis and Management

TL;DR

This case report describes a 77-year-old man with perforated gallbladder and severe heart condition managed without surgery.

Contribution

The report highlights non-surgical management of perforated cholecystitis in a patient with severe aortic stenosis.

Findings

Gallbladder perforation was diagnosed via CT scan in a patient with severe aortic stenosis.

Non-surgical treatment with a cholecystostomy tube was used instead of cholecystectomy.

The case demonstrates successful management of sepsis from gallbladder perforation in high-risk patients.

Abstract

Gallbladder perforation is a rare complication of acute cholecystitis that is associated with significant morbidity and mortality. Many cases of gallbladder perforation are not diagnosed until surgery, as the physical symptoms closely mimic acute cholecystitis. Gallbladder perforation is most common among older males with associated comorbidities, and preoperative assessment of comorbidities, particularly cardiac, is critical to determine the appropriate clinical course. We report a case of a 77-year-old male who presented initially with low blood pressure and right upper quadrant pain (RUQ) after not feeling well for five days. CT of the abdomen/pelvis with IV contrast demonstrated acute perforated cholecystitis, and general surgery was consulted for a cholecystectomy. Due to the patient’s past medical history of severe aortic stenosis (AS), cholecystectomy was deferred and a cholecystostomy tube was placed by interventional radiology. This report aims to provide an example of a case of perforated cholecystitis with sepsis and how it can be diagnosed and managed non-surgically in the presence of pre-existing severe AS.

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