Regarding the management of acalculous gallbladder disease in a critically ill ICU patient, which intervention is most appropriate if the patient is too unstable for general anaesthesia?

• A Emergency laparoscopic cholecystectomy
• B Open cholecystostomy under local anaesthesia
• C Percutaneous cholecystostomy under ultrasound guidance ✓
• D Broad-spectrum antibiotics alone until patient is stabilized for surgery

Explanation

Acute acalculous cholecystitis in critically ill patients carries a high perforation risk (up to 40%) and mortality. Percutaneous cholecystostomy (PC) under ultrasound or fluoroscopic guidance with local anaesthesia provides definitive decompression without general anaesthesia, and is the preferred rescue intervention in high-risk patients. The catheter can be left in situ until the patient is stable for definitive cholecystectomy or, in some cases (if no underlying calculi), the cholecystostomy tube can simply be removed once bile is sterile and the patient recovers.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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