American Board of Internal Medicine (ABIM) Certification Practice Exam

Which treatment modality is advisable for severe cases of acalculous cholecystitis?

1. Definitive surgical cholecystectomy

2. Intravenous fluid hydration only

3. Therapeutic decompression with percutaneous cholecystostomy

4. Trial of dietary modification

The correct answer is: Therapeutic decompression with percutaneous cholecystostomy

In severe cases of acalculous cholecystitis, therapeutic decompression with percutaneous cholecystostomy is advisable due to its effectiveness in managing the condition, especially in critically ill patients. Acalculous cholecystitis often occurs in patients who are hospitalized or have significant underlying medical problems, making traditional surgical approaches riskier and less preferred. Percutaneous cholecystostomy involves the placement of a catheter into the gallbladder under imaging guidance, allowing for drainage of the inflamed gallbladder. This approach provides a less invasive option that can stabilize the patient and alleviate symptoms. It can also serve as a bridge to definitive surgery if necessary after the patient’s condition improves. Definitive surgical cholecystectomy is typically the standard treatment for symptomatic gallbladder disease but may not be suitable immediate management in acute cases of acalculous cholecystitis, particularly when the patient is unstable or has significant comorbidities. Intravenous fluid hydration alone does not address the source of the inflammation, and dietary modification is not an appropriate intervention for acute cases. Thus, percutaneous cholecystostomy stands out as the most prudent and effective initial approach in managing severe