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Acute ascending cholangitis with septic shock — SCE Acute Medicine MCQ

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HardSepsis and Infectious EmergenciesAcute ascending cholangitis with septic shockSCE Acute Medicine

A 55-year-old man with severe acute pancreatitis develops progressive oliguria, rising ventilatory pressures and tense abdominal distension despite resuscitation. Bladder pressure is 27 mmHg and lactate is increasing. CT shows ascites without infected necrosis. What is the most appropriate next step?

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Correct answer: A — Arrange urgent surgical decompression with critical-care support

New organ dysfunction with sustained intra-abdominal pressure above 20 mmHg defines abdominal compartment syndrome. Optimise sedation, gastric and colonic decompression, fluid balance and percutaneous drainage when appropriate, but progressive organ failure at 27 mmHg requires urgent surgical-critical-care decompression planning. Further indiscriminate fluid can worsen intra-abdominal pressure.

Reference: https://www.nice.org.uk/guidance/ng104/chapter/recommendations; https://pmc.ncbi.nlm.nih.gov/articles/PMC3680657/