Building a world-class emergency medicine system: Qatar's strategic evolution and outcomes.

Gallbladder stones combined with common bile duct stones are frequently encountered in elderly patients, and the standard minimally invasive management consists of Endoscopic Retrograde Cholangiopancreatography (ERCP) for stone extraction followed by laparoscopic cholecystectomy (LC) (). Postoperative infectious complications remain a notable clinical concern despite the advantages of minimally invasive procedures (). () is a highly virulent pathogen that can induce life-threatening systemic infection (), yet postoperative sepsis caused by this organism is extremely rare in patients undergoing biliary endoscopic and surgical interventions. This case reports a rare sepsis following combined ERCP and LC, which was rapidly rescued with the 1 h sepsis bundle. This report emphasizes the importance of early recognition of rare pathogenic infections, prompt implementation of standardized sepsis protocols, and strict infection control in elderly high-risk patients undergoing biliary endoscopic and surgical procedures. A 76-year-old married woman, with a history of hypertension and diabetes but no other medical or family history, presented with recurrent right upper quadrant pain for over a month. She exhibited mild tenderness and a positive Murphy’s sign. An MRI revealed a nodular filling defect in the distal common bile duct and mild dilation of the proximal duct, along with a thickened gallbladder wall and a nodular defect within the gallbladder. She was diagnosed with gallbladder stones and common bile duct stones. Given the patient’s advanced age and poor health, and after thorough discussion and considering their wishes, we opted for a staged treatment: first ERCP to remove the stones, then LC.