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Acalculous Cholecystitis Neutropenia — SCE Medical Oncology MCQ

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HardOncological EmergenciesAcalculous Cholecystitis NeutropeniaSCE Medical Oncology

A neutropenic patient receiving chemotherapy has acute acalculous cholecystitis. Despite broad-spectrum intravenous antibiotics and resuscitation, fever and right-upper-quadrant pain persist; CT shows progressive gallbladder distension without perforation, and operative risk remains high. What is the best next source-control step?

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Correct answer: A — Continue antibiotics and add percutaneous image-guided cholecystostomy drainage

Persistent acalculous cholecystitis in a profoundly neutropenic high-risk surgical patient needs source control, usually percutaneous gallbladder drainage alongside antibiotics. Continue broad-spectrum antibiotics and add granulocyte-colony stimulating factor: marrow recovery does not provide gallbladder source control. Continue broad-spectrum antibiotics and perform endoscopic transpapillary drainage: transpapillary drainage is a specialist alternative rather than the usual percutaneous route in this anatomy. Continue broad-spectrum antibiotics and perform urgent laparoscopic cholecystectomy: profound neutropenia and high operative risk favour a less invasive bridge. Continue broad-spectrum antibiotics and perform endoscopic nasogallbladder drainage: this can be used selectively but is not the standard first source-control route in a high-risk patient.

Reference: NICE CG188 gallstone disease: diagnosis and management (Published October 2014; current NICE guidance): https://www.nice.org.uk/guidance/cg188/chapter/Recommendations; NICE NG15 antimicrobial stewardship: recommendations (Published August 2015; current NICE guidance): https://www.nice.org.uk/guidance/ng15/chapter/recommendations; Acute cholecystitis in neutropenic patients (Published August 2019): https://pubmed.ncbi.nlm.nih.gov/31501811/