Facharzt FMH Chirurgie Practice Questions - Facharzt FMH Für Chirurgie Spécialiste FMH En Chirurgie Exam

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A 74-year-old male is admitted with a 24-hour history of severe right upper quadrant pain, high-spiking fevers with rigors (39.5°C), jaundice, confusion, and hypotension (blood pressure 82/50 mmHg, heart rate 124 bpm, refractory to fluid bolus). Laboratory evaluation reveals total bilirubin 95 µmol/L, alkaline phosphatase 420 U/L, WBC 22.0 × 10^9/L, and arterial lactate 4.1 mmol/L. Abdominal ultrasound shows common bile duct dilatation (14 mm) with an impacted stone at the distal choledochus. What is the most critical emergency intervention after initiating resuscitation and broad-spectrum antibiotics?

Emergency open choledochotomy and T-tube placement under general anesthesia Immediate intravenous administration of high-dose corticosteroids and ursodeoxycholic acid Emergent exploratory laparotomy with subtotal cholecystectomy Urgent biliary decompression via Endoscopic Retrograde Cholangiopancreatography (ERCP) with sphincterotomy/stenting

Correct Answer:

Urgent biliary decompression via Endoscopic Retrograde Cholangiopancreatography (ERCP) with sphincterotomy/stenting

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