Background: The management of acute severe cholecystitis (ASC) in patients with recent cardiovascular events presents a significant clinical dilemma. The balance between urgent surgical necessity and high perioperative cardiac risk requires a synchronized multidisciplinary approach to ensure patient safety and optimal outcomes.

Case Presentation: We present a case of a 57-year-old male with a recent inferior wall myocardial infarction (MI), heart failure (HF) with a reduced ejection fraction (LVEF 40-45%), and severe three-vessel coronary artery disease (3VCAD). The patient developed ASC complicated by gallbladder perforation and a pericholecystic abscess. Initial conservative management and ultrasound-guided percutaneous drainage were unsuccessful, with the patient showing signs of clinical deterioration and impending sepsis.

Management & Multidisciplinary Approach: Due to the critical nature of the gallbladder perforation and the patient's unstable cardiac status, a multidisciplinary consensus between the surgical and cardiology teams was reached. Despite the high risk of hemodynamic collapse under general anesthesia, an open cholecystectomy was performed successfully. Postoperatively, the patient was stabilized and subsequently underwent percutaneous coronary intervention (PCI), including stenting of the RCA and LCX, to manage his underlying coronary disease.

Conclusion: This case highlights the challenges of managing life-threatening surgical emergencies in patients with severe cardiac comorbidities. It underscores the vital importance of a multidisciplinary "Heart-Surgery Team" approach in navigating high-risk decisions, demonstrating that even in complex cases, coordinated intervention can lead to a successful recovery and comprehensive management of both acute surgical and chronic cardiac conditions.

Mahmoud Abdulkareem is a Senior Consultant of General and Laparoscopic Surgery at King Fahad Specialist Hospital (KFSH) in Buraidah, Al-Qassim, Kingdom of Saudi Arabia. With a career marked by clinical excellence and academic dedication, he holds prestigious international certifications, including an MS (Cairo), FRCS (Glasgow), and is a Fellow of the American College of Surgeons (FACS).

In addition to his clinical expertise, he is a cornerstone of surgical education in the region. He serves as a Principal Trainer for the Saudi Fellowship in Surgery, where he plays a vital role in shaping the next generation of Saudi surgeons. His significant contributions to medical education have also earned him the title of Assistant Professor in Clinical Surgery at the Al-Qassim Faculty of Medicine, in recognition of his extensive work in teaching and mentoring medical students.

He is deeply interested in the latest surgical developments and is a strong advocate for multidisciplinary clinical practice. His participation in this conference highlights his expertise in managing complex surgical emergencies, particularly in high-risk patients with co-existing cardiovascular conditions.