Simultaneous surgical treatment tactics of acute destructive cholecystitis combined with choledocholithiasis: A case...

The widespread development of minimally invasive treatment methods have expanded the choices and options available to surgeons to manage patients suffering from cholelithiasis and its complications, including choledocholithiasis. As new surgical strategies are developed and become widely available, there is an ongoing debate as to which surgical strategies are optimal for the management of acute cholecystitis and concomitant choledocholithiasis. The treatment of patients in this category should be carried out according to clear criteria, taking into consideration the patient's condition, concomitant diseases, the size of calculi in the common bile duct as well as the resources of the medical institution.

We present the clinical case of a 65-year-old female with cholelithiasis, acute gangrenous cholecystitis, choledocholithiasis, and obstructive jaundice. She was treated with endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic papillosphincterotomy (EPST) and laparoscopic cholecystectomy (LCE) in a one-stage operation.

Several sources recommended performing LCE after ERCP with EPST in acute cholecystitis when complicated by choledocholithiasis to reduce the conversion rate and the risk of recholedocholithiasis.

Simultaneous resolution of acute destructive cholecystitis complicated by choledocholithiasis in a one-stage operation is accompanied by a decrease in emotional and psychological trauma, also leads to early rehabilitation of patients and, thereby, reduces overall postoperative disability and morbidity.