Gangrenous cholecystitis (GC), a severe complication of acute cholecystitis, is associated with higher morbidity and mortality rates than uncomplicated cholecystitis. In this report, we present the case of an 81year-old female with diabetes mellitus and hypertension who presented in the emergency department complaining of severe generalized abdominal pain for 10 days. The pain was associated with nausea and vomiting. She had septic shock, prompting admission, and was eventually diagnosed with perforated GC. Interventional radiology was conducted, and a cholecystostomy tube was placed under radiology guidance with continuous daily irrigation and intravenous antibiotic coverage for four weeks. Subsequently, the patient's condition improved, and she was finally discharged.

Obesity can promote several metabolic, cardiovascular, and musculoskeletal complications and has been associated with poor quality of life. The treatment of obesity can range from simple lifestyle modifications or medications to complicated bariatric surgeries. Although bariatric surgery has been a proven treatment for morbid obesity, it has also been associated with multiple consequences and complications. Several reports and studies have revealed bone loss or decreased bone mineral density (BMD), fractures, or even several metabolic bone diseases, such as osteoporosis, following bariatric surgery. This case report aims to increase awareness on postoperative patient supplementation compliance and incorporation of early detection and intervention. This case report involves a 39-year-old male who underwent laparoscopic biliopancreatic diversion 10 years prior to presentation. The patient was not compliant with his supplements for over nine years, which lead to multiple fragility fractures, myopathy, and muscle atrophy due to hypocalcemia, vitamin D deficiency, hyperparathyroidism, and other electrolyte disturbances. He has since been treated with supplements and physiotherapy for 10 months and showed clinical improvement. This case report highlights the importance of pre-and postoperative screening of bone loss risks and any vitamin or mineral deficiencies with subsequent correction via supplements. Moreover, it emphasizes the need for more studies on the complications of late post-bariatric surgeries.