Synchronous Acute Cholecystitis and Perforated Acute Appendicitis in a 49-Year-Old Male Patient in Jordan: A Case...

Acute appendicitis (AAP) and acute cholecystitis (AC) are two of the most common surgical emergencies, yet their synchronous occurrence is exceptionally rare and diagnostically challenging. We report the case of a 49-year-old male patient who presented with a 10-day history of diffuse abdominal pain, nausea, vomiting, anorexia, and dark urine. Examination revealed abdominal tenderness with positive Murphy's and rebound signs. Laboratory tests demonstrated leukocytosis, neutrophilia, and elevated liver enzymes. Imaging with combined ultrasound and computed tomography confirmed both an inflamed, stone-bearing gallbladder and an enlarged, fluid-filled appendix. Diagnostic laparoscopy revealed active pelvic purulence and a severely inflamed gallbladder with dense inflammation at the hepatocystic triangle. Prioritizing definitive source control while avoiding iatrogenic biliary manipulation in a contaminated field, cholecystectomy was deferred. The patient underwent an appendectomy, which was converted to an open gridiron approach due to severe adhesions and tissue friability obscuring the appendiceal base. Index histopathology confirmed perforated AAP with serositis. Postoperatively, the patient was readmitted on day 14 with a superficial incisional surgical-site infection; this was successfully managed with bedside drainage and antibiotics after imaging ruled out deep intra-abdominal collections. Three months later, the patient underwent an uncomplicated interval laparoscopic cholecystectomy, with final histopathology confirming chronic cholecystitis. The rarity of this presentation highlights the need for high clinical suspicion. Synchronous perforated AAP with AC remains a rare diagnostic challenge in atypical abdominal pain. Early multimodal imaging and individualized operative planning, including staged intervention when severe inflammation or unsafe anatomy precludes simultaneous resection, may be considered to optimize patient safety.