A different bail-out scenario for chronic cholecystitis surgery: A case presentation

Chronic cholecystitis, frequently caused by recurrent inflammation of gallbladder due to gallstones, can cause diagnostic challenges, particularly when it mimics gallbladder malignancy. This report describes a 63-year-old male with a medical history of diabetes mellitus and major depression, who presented with abdominal pain and jaundice due to gallstone impaction in the common bile duct. Initial management involved endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction, followed by surgical intervention. During laparoscopy, extensive adhesions and a solid mass suspicious for gallbladder carcinoma were observed. Since solid mass led to gastric outlet obstruction intraoperative gastroscopy was performed. The gastroscopy revealed a stricture caused by external compression of mass in the first part of the duodenum. A gastroenterostomy was performed, and an incisional biopsy of the gallbladder was obtained. The histopathological evaluation resulted in non-diagnostic findings. The patient was re-evaluated by a multidisciplinary team with updated radiological imaging. An elective open cholecystectomy was successfully performed two months after the initial surgery. This case highlights the diagnostic challenges of chronic cholecystitis and presents a different bail-out scenario for gallstone ileus, emphasizing the importance of multidisciplinary decision-making and optimal timing in cases of acute-on-chronic cholecystitis.