Scenario 1: A 38-year-old Hmong Woman

A married, 38-year-old Hmong mother of eight arrived at the emergency room complaining of severe right upper quadrant pain, fever, nausea, and vomiting. Ultrasound evaluation demonstrated significant gallbladder disease with signs of advanced infection.

The woman was intubated and underwent an emergency Endoscopic Retrograde Cholangio-pancreatography (ERCP) to drain pus from her gallbladder. Blood cultures quickly grew three strains of bacteria. Her blood pressure dropped and she was taken to the intensive care unit with a diagnosis of acute cholecystitis, ascending cholangitis and bacterial sepsis.

The preferred treatment for this possibly fatal condition was emergency surgery. The family refused.

What is your first reaction to this scenario? Think about how you would you proceed with this patient. What would you recommend in this case?

When you have thought about this, click the forward arrow to advance.