A 78-year-old man presents to the Emergency Department with chest pain.

This presentation is consistent with acute acalculous cholecystitis, often seen in critically ill or post-MI patients. If unresponsive to antibiotics, percutaneous cholecystostomy is the preferred next step in those who are poor surgical candidates.

Toronto Notes 2023 – General Surgery, “Hepatobiliary Disorders” Section:

“Acalculous cholecystitis occurs in critically ill patients and is often managed with percutaneous cholecystostomy if the patient is not a candidate for surgery.”

MCCQE1 Objectives (Surgery > 84-3: Biliary Disease):

“Candidates must be able to diagnose and manage acalculous cholecystitis. Management includes antibiotics and drainage via percutaneous cholecystostomy in unstable patients.”

Laparoscopic cholecystectomy (C) is standard but not suitable in acutely ill ICU patients. Broadening antibiotics (A) alone is insufficient after failure of initial therapy. ERCP (B) is for biliary obstruction or cholangitis. HIDA scan (E) is diagnostic, not therapeutic.