Description
A 70-year-old male presented to the Accident and Emergency Department with a 4-day history of abdominal pain. On examination he was apyrexial, jaundiced and tender in the right upper abdominal quadrant. Laboratory investigations revealed a normal white cell count (WCC) and abnormal liver function tests (ALT 199 IU/l, ALP 243 IU/l and bilirubin 56 umol/l). A presumptive diagnosis of acute cholecystitis was made and he was commenced on intravenous cefuroxime and metronidazole. An ultrasound scan revealed a distended thickened gallbladder with multiple gallstones and a dilated common bile duct containing no gallstones. Two days later, because of shock, hypoxia, worsening liver function tests and disseminated intravascular coagulation, he was transferred to intensive care for ventilatory and ionotropic support. Nine days later he was sufficiently stable to be transferred to a surgical ward.
