A Complex Case of Acalculous Cholecystitis, Cholangitis, and Pancreatitis Managed With Percutaneous Cholecystostomy in a Septic Patient

This case report presents a complex case of acute cholecystitis, cholangitis, pancreatitis, intrahepatic abscesses, and sepsis without biliary obstruction, highlighting the challenges of managing multi-organ involvement in a critically ill individual. The patient, a middle-aged male, presented with fever, jaundice, and abdominal pain, with imaging revealing biliary ductal dilation, a distended gallbladder, and a staghorn calculus. Laboratory findings showed elevated liver enzymes, bilirubin, and lipase, supporting the diagnosis of acute cholecystitis, cholangitis, and pancreatitis. Given the severity of his condition, characterized by septic shock and acute kidney injury, percutaneous cholecystostomy (PCT) was chosen over surgical intervention to provide biliary drainage and infection control while avoiding the morbidity associated with invasive procedures. The patient's clinical course improved with PCT, targeted antibiotics, and supportive care. This case underscores the complexity of managing multi-organ dysfunction and highlights the potential of PCT as a viable alternative to surgery in critically ill patients with severe cholecystitis and cholangitis with intrahepatic abscesses. The simultaneous occurrence of these conditions in the context of no biliary obstruction is uncommon, and this case offers insight into treatment strategies for such complex presentations. Future research should compare the outcomes and symptomatology of PCT versus surgery in similar critically ill populations to refine management approaches and optimize patient outcomes.