A Case Report of a Patient With Severe Motor and Intellectual Disabilities (SMIDs) With Severe Physique Deformity, Who Underwent Cholecystectomy for Cholangitis and Cholecystolithiasis

Abstract

We describe the case of a 19-year-old male who was born at 31 weeks and 0 days of gestation owing to early placenta detachment. He lived in a facility for individuals with severe motor and intellectual disabilities (SMIDs) because of severe neonatal asphyxia (Oshima’s classification: class 1). On the day of admission, he developed fever and tachycardia. He was diagnosed as having cholangitis (Tokyo Guidelines 2018/2013 severity criteria: grade 1) and gallbladder stone disease. He was discharged with conservative treatment, but a month later, he returned to our hospital with recurrence of cholangitis. We planned endoscopic retrograde cholangiopancreatography (ERCP) and surgery. We expected the procedures to be difficult because of his severe physical deformity. Nevertheless, we completed ERCP and cholecystectomy by devising endoscopic procedures and a surgical field. Careful examination and preparation across multiple departments are important for completing the surgical treatment of gallstones in patients with severe physical deformities.