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Acute cholangitis — SCE Acute Medicine MCQ

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HardAcute GI PresentationsAcute cholangitisSCE Acute Medicine

A ventilated patient receiving vasopressors after major trauma develops fever, rising bilirubin and right upper-quadrant tenderness. Ultrasound shows a distended thick-walled gallbladder with pericholecystic fluid but no stones. He is too unstable for general anaesthesia. What is the most appropriate source-control strategy?

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Correct answer: D — Perform image-guided percutaneous cholecystostomy for source control

The findings suggest acute acalculous cholecystitis, which occurs in critically ill patients and can progress rapidly to gangrene or perforation. An unstable patient who is not fit for cholecystectomy usually needs image-guided percutaneous gallbladder drainage plus antimicrobials. ERCP addresses common-bile-duct obstruction, which is not demonstrated here.

Reference: https://www.nice.org.uk/guidance/HTG617/chapter/2-the-condition-current-treatments-and-procedure