•Am J Med Surg June 2024; 16 (2). 20-23 www.amjmedsurg.org DOI 10.5281/zenodo.11650990 Copyright 2024 © Unauthorized reproduction of this article is prohibited. Emergency surgical management in severe cholangitis and hepatic abscess following laparoscopic Rendez- Vous cholecystectomy. A case report Alexis Andrei Granados Flores M.D. Dorian Iván Arriola Ríos M.D. José Roberto González Soto M.D. David Humberto Acevedo Villafaña M.D. Perla Gabriela Rubio Vega M.D. Agustín Fraga Ramos M.D. Goretti Yáñez Ochoa M.D. Jesús Andrés Zambada Montaño M.D. Alonso Joseph Martinez Gómez M.D. Alexsandra Castillo Ibarra M.D. Ciudad Juárez, Mexico he term "choledocholithiasis" refers to the condition where stones are found in the common bile duct, frequently as a result of gallstones moving from the gallbladder. These stones develop as a result of supersaturation of cholesterol, insufficient bile salt levels or function, and decreased biliary epithelium contractility caused by different factors such as diet, hormones, and genetic predisposition. Cholangitis and pancreatitis are two major side effects of choledocholithiasis. [1] Cholangitis can be defined as the inflammation and infection of the bile duct, first described in 1877 by Jean-Marie Charcot. It constitutes a potentially fatal clinical entity. The typical clinical presentation includes jaundice, abdominal pain, and fever, known as Charcot's triad, which can be associated with hypotension and altered mental status, referred to as Reynolds' pentad. Various microorganisms may be implicated, with the most common being Escherichia coli, Klebsiella pneumoniae, Streptococcus faecalis, Enterobacter, Bacteroides fragilis, and Pseudomonas. [2-5] Acute cholangitis can be classified based on its severity into mild, moderate, and severe. Determining the severity of the disease is essential to administering the appropriate treatment. [6] Antimicrobial therapy and biliary drainage are the cornerstones of treatment for cholangitis. The following antibiotics are recommended based on the severity of cholangitis and whether it is community- acquired or associated with healthcare. [7] Hepatic abscesses can be defined as localized collections of pus surrounded by inflammatory tissue in the hepatic parenchyma. Literature suggests that liver abscesses are associated with patients who have a history of biliary-enteric anastomosis surgeries or the placement of biliary stents, the latter often associated with papillotomy which increases the risk of bacteriobilia. [10,11] The most common microorganisms involved in hepatic abscesses are Escherichia coli, Streptococcus spp., Klebsiella pneumoniae, Enterococcus spp., Bacteroides, and Fusobacteria, with up to 16% being polymicrobial. [12,13] Case report A 52-year-old female patient presented with a one-week history of right upper quadrant abdominal pain, nausea, vomiting, and jaundice. An abdominal ultrasound revealed multiple gallstones, a thickened gallbladder wall (7 mm), and a dilated common bile duct (10 mm), leading to a diagnosis of choledocholithiasis and chronic lithiasic cholecystitis (Tokyo II). The patient was admitted for laparoscopic cholecystectomy (rendez-vous procedure), and a Penrose drain was placed. Five days post-surgery, bile continued to drain T Background: This case report presents a 52-year-old female patient diagnosed with septic shock secondary to cholangitis, hepatic abscess, and peritonitis, with a history of laparoscopic rendezvous cholecystectomy secondary to choledocholithiasis. Emergency management in a second-level public hospital in Mexico is discussed. We consider it helpful for healthcare professionals to know how serious complications can become after choledocholithiasis. Keywords: Cholangitis, Cholecystectomy, Laparoscopic surgery. General Surgery Case Report From the General Surgery Departament, Regional General Hospital No. 66, Ciudad Juárez, México. Received on June 7, 2024. Accepted on June 12, 2024. Published on June 13, 2