Patel Sahil, Joppen Jeffrey, Rahman Syed, Sheth Divya, Patel Achal
Internal Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA.
Gastroenterology and Hepatology, Nassau University Medical Center, East Meadow, USA.
Cureus. 2025 Aug 8;17(8):e89636. doi: 10.7759/cureus.89636. eCollection 2025 Aug.
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.
本病例报告展示了一例复杂的急性胆囊炎、胆管炎、胰腺炎、肝内脓肿和脓毒症病例，且无胆道梗阻，突出了在危重症患者中管理多器官受累情况的挑战。患者为一名中年男性，出现发热、黄疸和腹痛，影像学检查显示胆管扩张、胆囊增大和鹿角形结石。实验室检查结果显示肝酶、胆红素和脂肪酶升高，支持急性胆囊炎、胆管炎和胰腺炎的诊断。鉴于其病情严重，以感染性休克和急性肾损伤为特征，选择经皮胆囊造瘘术（PCT）而非手术干预，以提供胆道引流和控制感染，同时避免侵入性操作相关的发病率。通过PCT、针对性抗生素治疗和支持性护理，患者的临床病程得到改善。本病例强调了管理多器官功能障碍的复杂性，并突出了PCT作为患有严重胆囊炎、胆管炎和肝内脓肿的危重症患者手术可行替代方案的潜力。在无胆道梗阻的情况下同时出现这些病症并不常见，本病例为这类复杂病症的治疗策略提供了见解。未来的研究应比较PCT与手术在类似危重症人群中的结果和症状，以完善管理方法并优化患者预后。
