A 49-year-old woman is admitted to the hospital with abdominal pain. Physical examination reveals an epigastric pain that migrates toward the patient’s right side and posteriorly toward the scapula. Radiographic examination reveals cholecystitis with a large gallstone and no jaundice. In which of the following structures is it most likely the gallstone will be located?

**Core Concept**
The clinical presentation suggests a gallstone causing **cholecystitis**, which is inflammation of the gallbladder, often due to gallstones. The pain pattern described is classic for **biliary colic**. Understanding the anatomy of the biliary tree and the pathophysiology of gallstone disease is crucial.

**Why the Correct Answer is Right**
Given the presence of a large gallstone and cholecystitis without jaundice, it's likely the stone is still in the gallbladder or has moved to the cystic duct, as jaundice typically occurs when a stone obstructs the common bile duct. The cystic duct connects the gallbladder to the common bile duct. Since there's no jaundice, the stone hasn't reached or obstructed the common bile duct, making the cystic duct or gallbladder the most likely location.

**Why Each Wrong Option is Incorrect**
**Option A:** This would be incorrect because if the stone were in the common bile duct, it would likely cause jaundice due to obstruction of bile flow into the intestine.
**Option B:** Incorrect because the stone's presence in the common hepatic duct would also likely cause jaundice.
**Option D:** This is incorrect as it's less likely for the stone to have passed into the small intestine without causing significant symptoms or jaundice prior to this point.

**Clinical Pearl / High-Yield Fact**
A key point to remember is that the absence of jaundice in a patient with cholecystitis and a large gallstone suggests the stone has not yet obstructed the common bile duct.

**Correct Answer:** C. Cystic duct or gallbladder

✓ Correct Answer: B. Hartmann pouch