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Acute ascending cholangitis — MCCQE Part 1 MCQ

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HardJaundiceAcute ascending cholangitisMCCQE Part 1

A 46-year-old is admitted with gallstone pancreatitis. After fluid resuscitation and analgesia, pain and oral intake improve. There is no organ failure, necrosis, cholangitis, or persistent common-bile-duct obstruction; bilirubin is falling and ultrasound shows gallstones without duct dilatation. Which plan best reduces early recurrent biliary events?

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Correct answer: B — Perform laparoscopic cholecystectomy during the index admission

This is mild gallstone pancreatitis: the patient has improved, without persistent organ failure, necrosis, cholangitis, or continuing biliary obstruction. Canadian guidance recommends laparoscopic cholecystectomy during the same admission once clinically appropriate. This substantially reduces recurrent pancreatitis, cholecystitis, and cholangitis that can occur while a patient waits for interval surgery. Routine urgent ERCP is not indicated when there is no cholangitis or evidence of persistent common-bile-duct obstruction. Delaying surgery is appropriate in severe necrotizing pancreatitis or important ongoing local complications, not as a universal rule. If a patient cannot undergo cholecystectomy during the index admission because of major comorbidity, ERCP with sphincterotomy before discharge can reduce recurrence, but it is an alternative for nonsurgical candidates rather than the preferred plan here. Antibiotics do not prevent gallstone recurrence.

Reference: Greenberg et al., Clinical Practice Guideline: Management of Acute Pancreatitis: https://pmc.ncbi.nlm.nih.gov/articles/PMC4814287/