Case Study: What would you do? – Dr. Ravinder Singh
Original Case Query:
82 Male with a PMHx of Atrial Fibrillation on anticoagulation, and a pacemaker. Presents with upper abdominal pain, nausea, and vomiting. This has been periodic over the last several months but worse in the last several days. Otherwise stable. Blood work ok. CT scan is as follows: sludge in the gallbladder; no biliary dilatation; LFTs normal.
What would be your management?
a. Antibiotics alone and reassess need for cholecystectomy at a later date
b. Antibiotics and Cholecystostomy (after NOAC is held for 48-72h)
c. Antibiotics and Cholecystectomy (after NOAC is held for 48-72h)
d. Send to HPB
Actual Case Outcome:
82 M had presented with Acute Cholecystitis. He had an attempted laparoscopic cholecystectomy but there was significant inflammation and thus a cholecystostomy was placed (JP drain). The drain subsequently stopped draining, and the patient despite being stable was not improving. He complained of persistent RUQ pain. Repeat CT POD#10 showed active intra-mural hemorrhage in the gallbladder wall with a surrounding hematoma, and another intra-abdominal hematoma. Decision was then to transfer to HPB surgeon for further management. Subsequently he had an open sub-total cholecystectomy.
Poll Results: download
