Acute Calculous Cholecystitis with Choledocholithiasis in a 75-Year-Old Male: A Case Report on Multidisciplinary Management

Abstract

Acute calculous cholecystitis with choledocholithiasis is a common surgical emergency, particularly in the elderly population. The presence of obstructive jaundice with cholangitis significantly increases morbidity and mortality, necessitating prompt diagnosis and multidisciplinary management. We report the case of a 75-year-old male with multiple comorbidities—including type 2 diabetes mellitus, hypertension, hypothyroidism, and benign prostatic hyperplasia—who presented with acute calculous cholecystitis and obstructive jaundice. Laboratory investigations revealed a cholestatic pattern with elevated bilirubin (total 2.62 mg/dL, direct 2.17 mg/dL), markedly elevated alkaline phosphatase (333 U/L), gamma-glutamyl transferase (526 U/L), and transaminitis (ALT 104 U/L, AST 67 U/L). His HbA1c was 7.7%, indicating poor glycemic control. The patient was managed with aggressive medical optimization, including insulin therapy for glycemic control, nil per oral, intravenous fluids, and antibiotics. A multidisciplinary approach involving hepatobiliary surgeons, endocrinologists, and anesthesiologists was adopted. This case highlights the importance of comprehensive preoperative optimization, the role of endoscopic retrograde cholangiopancreatography in managing choledocholithiasis, and the challenges of managing acute biliary pathology in elderly patients with significant comorbidities. Early recognition, appropriate antibiotic therapy, glycemic control, and timely surgical intervention are essential for favorable outcomes.