SUCCESSFUL TREATMENT OF GANGRENOUS CHOLECYSTITIS IN A PATIENT WITH MULTIPLE COMPLEX COMORBIDITIES

Doctors at Nam Sai Gon International General Hospital recently saved the life of a 60-year-old Cambodian man suffering from gangrenous cholecystitis caused by biliary sludge, which had leaked into the abdominal cavity and triggered peritonitis — a dangerous condition that can become life-threatening if not treated promptly.

Complex Case of Gangrenous Gallbladder with Severe Underlying Conditions

The patient, Mr. M.P. (60 years old, Cambodian), was admitted to the hospital in critical condition and diagnosed with gangrenous cholecystitis with bile leakage into the peritoneal cavity. His situation was further complicated by numerous underlying health issues, including recent ischemic stroke (1 month prior), acute pneumonia, hypertension, type 2 diabetes, dyslipidemia, hyponatremia, and stage III chronic kidney disease. 

Given these multiple comorbidities, medical stabilization prior to surgery was deemed essential to reduce surgical risk and increase the chances of a successful outcome.

According to Dr. Nguyen Trung Duong, MMed, Specialist Level II, the attending physician:

“This was a highly complex and dangerous case. Gangrenous cholecystitis itself is a surgical emergency, but bile leakage into the abdominal cavity significantly increased the risk of severe infection and sepsis. In addition, the patient’s overall health was severely compromised by multiple chronic illnesses, making him extremely vulnerable. That’s why we prioritized intensive medical management before proceeding with surgery”.

Gangrenous cholecystitis occurs when the gallbladder becomes severely inflamed and its tissue begins to die, usually due to gallstone obstruction. Bacterial infection spreads rapidly, leading to tissue necrosis. If untreated, the gallbladder can perforate, releasing pus and bile into the abdominal cavity — causing peritonitis, a life-threatening infection that can result in septic shock and multi-organ failure.

After one month of inpatient medical management to treat pneumonia and stabilize his chronic conditions, the patient was deemed fit for surgery. A laparoscopic cholecystectomy was performed by Dr. Nguyen Trung Duong, MMed, Specialist Level II and Dr. Mai Van Dung, MMed, Specialist Level I both from the General Surgery Department.

Upon exploration, the surgical team noted a thickened, inflamed gallbladder wall with necrotic foci, and adhesions to surrounding omentum. Thanks to the team’s expertise and the use of advanced surgical equipment, the procedure was completed smoothly in two hours.

Dr. Duong explained:

“In most cases, gallbladder removal can be performed laparoscopically. This involves making a few small incisions in the abdomen, inserting a camera-equipped laparoscope, and using specialized instruments to remove the gallbladder. The procedure offers several benefits — smaller incisions, reduced pain, faster recovery, minimal scarring, and fewer complications. However, in certain complex cases, we may convert to open surgery to ensure patient safety”.

The patient was discharged five days after surgery, although the total hospitalization time was over a month due to his prior health conditions. This case underscores the importance of early detection and timely treatment of gallbladder disease, especially in patients with multiple comorbidities.

Medical Advice for Patients with Gallstones

Patients diagnosed with gallstones should seek evaluation and management at reputable, well-equipped medical facilities. Prompt treatment can help prevent complications such as gangrenous cholecystitis and bile-induced peritonitis.

In particular, if symptoms such as severe right upper quadrant pain, high fever, or chills occur, it is essential to seek emergency medical care immediately to avoid life-threatening complications.

Nam Sai Gon International General Hospital accepts both public health insurance and private health insurance.

Nam Sai Gon International General Hospital

No. 88, Street No. 8, Trung Son Residential Area, Binh Hung Commune, Ho Chi Minh City.

Hotline: 18006767

info@nih.com.vn

BRC: No. 0312088602, issued on December 14th, 2012 by the Department of Planning and Investment of Ho Chi Minh City. Medical Examination and Treatment License No. 230/BYT-GPHĐ, issued by the Ministry of Health.