Acute Severe Cholecystitis in a Patient With Acute Myocardial Infarction and Heart Failure: A Case Report.

Acute severe cholecystitis (ASC) is an advanced inflammatory and infectious disease of the gallbladder, often requiring immediate surgical intervention. In this case, we will discuss the management of a 57-year-old male with a history of recent inferior wall myocardial infarction (MI), heart failure (HF) with a left ventricular ejection fraction (LVEF) of 40-45%, and severe three-vessel coronary artery disease (3VCAD). The patient case presented to the surgical team at the King Fahad Specialist Hospital (KFSH) with acute cholecystitis complicated by gallbladder perforation and a pericholecystic abscess, confirmed through computed tomography (CT). With the patient's cardiac status, it was a difficult decision to operate immediately due to the potential for hemodynamic instability under general anesthesia. Initially, we considered a conservative approach with intravenous antibiotics, followed by ultrasound-guided percutaneous drainage of the abscess. Unfortunately, due to the ineffectiveness of the drainage and the increasing risk of sepsis, a multidisciplinary consultation was held, which arrived at a consensus to perform an open cholecystectomy. The surgical procedure was successful, with no complications. After 10 days, we conducted a percutaneous coronary intervention (PCI), involving stenting of the right coronary artery (RCA) and left circumflex artery (LCX), and balloon angioplasty of the left anterior descending artery (LAD), to improve the cardiac blood flow. The patient was discharged in a stable condition 12 days after the cholecystectomy. In this paper, we aim to highlight the complex management approach to such high-risk scenarios and achieving a positive patient outcome.