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Post-appendectomy abscess — USMLE Step 3 MCQ

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HardSurgery (post-operative, follow-up)Post-appendectomy abscessUSMLE Step 3

A mechanically ventilated patient receiving vasopressors after major burns develops fever and right-upper-quadrant tenderness. Ultrasound shows gallbladder distention, wall thickening, and pericholecystic fluid without stones or ductal dilation. Despite antibiotics, shock persists, and the surgical team judges the immediate operative risk prohibitive. Which intervention is the best source-control option for this patient now?

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Correct answer: E — Perform urgent image-guided percutaneous cholecystostomy for gallbladder drainage

The best answer is “Perform urgent image-guided percutaneous cholecystostomy for gallbladder drainage”. The findings support acute acalculous cholecystitis without evidence of common-duct obstruction. Percutaneous cholecystostomy is not mandatory for every patient with acalculous cholecystitis; it is the best option in this exact setting because sepsis persists despite antibiotics and immediate operative risk is prohibitive. It provides source control while resuscitation continues.

Reference: ACR Appropriateness Criteria: Right Upper Quadrant Pain: https://acsearch.acr.org/docs/69474/Narrative/