A few days ago, the author successfully performed “choledochotomy and cholecystectomy” on an elderly and critically ill patient. The patient was elderly and in serious condition, with gallstones causing obstruction of the bile ducts, causing abdominal pain, jaundice, high fever and chills, and was considered to have “acute obstructive purulent cholangitis”. Once a patient with gallstones develops this condition, it is very dangerous and has a high mortality rate. The patient’s condition was critical and life-threatening at any time, so he was immediately transferred to the hepatobiliary surgery department. After rapid and adequate preoperative preparation, emergency surgery was performed. Through delicate surgery and comprehensive, highly skilled perioperative treatment, the patient recovered quickly and had a very good prognosis without a single complication and was discharged on schedule. The details are described below. Huang Gang, Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Guangzhou Medical University Patient Ye Moumou, male, 87 years old, from Guangzhou. He was admitted to the hospital with “abdominal pain for 3 days, aggravated for one day with yellowing of both eyes and skin and fever”. The patient started to have abdominal pain after drinking alcohol 3 days ago, and the pain was slightly relieved after taking “Zhengluwan” at home. 1 day ago, the abdominal pain worsened, and the skin of both eyes and the whole body turned yellow, so he came to the emergency department of our hospital, and the abdominal pain was slightly relieved after treatment. At noon today, the patient developed fever, chills, and became mentally worse. Urgent specialist consultation was requested. On examination, the patient was found to have abdominal pain, jaundice, high fever, chills, epigastric tenderness, rebound pain, positive Murphy’s sign, and percussion pain in the liver area. Abdominal ultrasound: multiple gallbladder stones with gallbladder siltation sonogram. Lower bile duct stones and dilated intra- and extra-hepatic bile ducts. Localized thickening of the common bile duct wall. Liver function: low albumin, significantly elevated total and direct bilirubin, 129.0 μmmol/L and 77.1 μmmol/L, respectively, and elevated glutamyl transpeptidase, 105 U/L. Blood count: elevated white blood cells, suggesting severe infection. Based on the physical examination and laboratory tests, the diagnosis of “acute obstructive purulent cholangitis” was made, and the condition was critical, with the risk of death at any time. The patient was immediately transferred to the Department of Hepatobiliary Surgery, where he had undergone a “major gastrectomy” and had severe abdominal adhesions due to long-term recurrent cholecystitis, which made the operation more difficult and risky. It was difficult to save the patient effectively without surgery, and the surgeon had to take great risks. In order to save the patient’s life, with decades of accumulated experience and fine surgical style, after rapid and adequate preoperative preparation, the decision was made on the spot and emergency surgery was performed. As in the preoperative analysis, the patient’s abdominal adhesions were very severe, with adhesions of the greater omentum, colon and mesentery to the peritoneum, gallbladder and liver surface in the upper abdomen, turbid ooze, bile-like fluid and pus moss in the abdominal cavity. Hepatic bile sludge, edema of the tissues around the common bile duct, wall thickening, dilated common bile duct and common hepatic duct with a diameter of more than 2 cm (normal is less than 8 mm), dark bile in the lumen, purulent fluid and pus moss, stones in the lower part of the common bile duct with a diameter of about 2 cm, enlarged gallbladder with fluid accumulation, size of about 15*7 cm, pus moss on the surface, severe edema and thickening of the wall, multiple stones in the lumen of the gallbladder with a maximum diameter of about 1.2 cm, gallbladder duct The diameter was about 0.8cm (normal is below 3mm). Because the abdominal adhesions were very serious, each step of the operation needed to be very accurate and gentle, and the slightest carelessness could cause hemorrhage and break the intestinal wall, etc. Every action needed to be especially careful and accurate. The operation went smoothly with little bleeding. Through delicate surgery and comprehensive and superb perioperative treatment, the patient recovered quickly and had a very good prognosis without a single complication and was discharged on schedule. After the surgery, the patient and his family were so grateful that they wrote a heartfelt letter of thanks to the hospital office, thanking the director for his conscientiousness, enthusiasm, skillfulness, comprehensiveness and attentiveness!