A 62-year-old man with fever, jaundice, and right upper quadrant pain develops systolic blood pressure of 80 mmHg and confusion. Ultrasound shows a dilated common bile duct with a stone at its lower end. After intravenous broad-spectrum antibiotics and fluid resuscitation, the definitive next step is:

• A Emergency open cholecystectomy
• B Magnetic resonance cholangiopancreatography before any intervention
• C Percutaneous transhepatic cholecystostomy
• D Urgent endoscopic sphincterotomy and stone extraction ✓

Explanation

Charcot triad plus shock and altered mental status constitutes Reynolds pentad, indicating acute suppurative cholangitis with septic shock. Source control of the obstructed biliary tree cannot wait, and urgent biliary decompression by ERCP with sphincterotomy and stone extraction is the standard definitive intervention. Cholecystectomy treats the gallbladder, not the obstructed duct, and cholecystostomy drains the gallbladder rather than the bile duct. Waiting for MRCP delays source control in a septic patient.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.