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Background. Acute cholecystitis in severely cardiopathic patient after major cardiac surgery represent a challenge for surgeons. Treatment with cholecystostomy could represent a chance for patients even if there are many topics of greatest debate about it: the technique of performing it (if transhepatic or transpapillary), the timing of optimal duration, the timing of drain removal, the need of further examinations before the removal as well as the timing for de nitive surgery. We therefore deemed important to share our experience in the treatment of acute cholecystitis in a severe cardiopathic patient, while attempting to clarify all the major topics related to the management of percutaneous cholecystostomy through a literary review. Case presentation. A 58-year-old severly cardiopathic patient who had undergone surgery for hip replacement, developed an acute calcolous cholecystitis a few days after surgery to resolve which a percutaneous cholecystostomy was the chosen strategy. Two weeks after discharge, a cholangiography through the cholecystostomy and a MRI cholangiopancreatography revealed the presence of stones in the cystic duct and in the ductus choledochus. The de nitive treatment was decided after consulting with a multidisciplinary team. An open cholecystectomy with simultaneous removal of the cholecystostomy, endoscopic removal of stones and sphincterotomy of the Oddi papilla was performed. The patient is currently healthy and his heart function is satisfactory. Conclusion. Although early cholecystectomy is the recommended choice for acute cholecystitis, a critically ill patients may bene t from a bridging therapy before de nitive surgery. The multidisciplinary approach provided a safer solution for this frail patient. Competing interest:: Authors certify that there is no actual or potential con ict of interest in relation to this article and they state that there are no nancial interests or connections, direct or indirect, or other situations that might raise the question of bias in the work reported or the conclusions, implications, or opinions stated-including pertinent commercial or other sources of funding for the individual author(s) or for the associated department(s) or organization(s), personal relationships, or direct academic competition. Funding: The authors state that no funding has been received for this article. Authors' Contribution: All authors have approved the submitted version (and any substantially modi ed version that involves the author's contribution to the study),and have agreed both to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.

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