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Gallstone pancreatitis with cholangitis — ESEGH MCQ

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HardPancreatico-biliary DiseaseGallstone pancreatitis with cholangitisESEGH

A 46-year-old woman presents with severe epigastric pain radiating to the back, fever and jaundice. Lipase is 1,800 IU/L, bilirubin 96 micromol/L and ALP 420 IU/L. Ultrasound shows gallstones and a dilated common bile duct. She becomes hypotensive despite fluids. What is the most appropriate management?

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Correct answer: A — Urgent ERCP with biliary decompression after resuscitation

Gallstone pancreatitis with cholangitis and shock requires urgent biliary decompression by ERCP alongside resuscitation and antibiotics. Cholecystectomy alone does not address obstructed infected bile duct in the acute setting. Steroids and colonoscopy are not relevant. The pearl is that ERCP in pancreatitis is reserved for obstruction or cholangitis, not uncomplicated cases.

Reference: NICE Pancreatitis Guideline NG104; BSG Acute Pancreatitis Guidance