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1110 Anaesthesia

A 73-year-old woman with a long history of heavy smoking undergoes femoral aery-popliteal aery bypass for rest pain in her left leg. Because of serious underlying respiratory insufficiency, she continues to require ventilatory suppo for 4 days after her operation. As soon as her endotracheal tube is removed, she begins complaining of vague upper abdominal pain. She has daily fever spikes of 39degC (102.2degF) and a leukocyte count of 18,000/mL. An upper abdominal ultrasonogram reveals a dilated gallbladder, but no stones are seen. A presumptive diagnosis of acalculous cholecystitis is made. Which of the following is the next best step in her treatment?

ANasogastric suction and broad-spectrum antibiotics
BImmediate cholecystectomy with operative cholangiogram
CPercutaneous drainage of the gallbladder
DEndoscopic retrograde cholangiopancreatography (ERCP) to visualize and drain the common bile duct
Anaesthesia
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