Laparoscopic Cholecystectomy in a Difficult Gallbladder: When to Convert?

Ryan W. Day, MD; Varun Jain, MBBS, MD; Daniel J. Johnson, MD, FACS

Product Details
Product ID: ACS-5514
Year Produced: 2018
Length: 7 min.


A 59 year-old male presented to the emergency department with an 11 day history of abdominal pain that he rated 9/10. He had been evaluated by an outpatient primary care physician and reportedly had a normal ultrasound of the gallbladder. He was started on ciprofloxacin for presumed colitis. Despite therapy, he continued to have pain and fever as an outpatient. On presentation, physical examination revealed focal peritonitis n the right upper quadrant with a positive Murphy's sign. Laboratory examinations were significant for leukocytosis to 19.5 and thrombocytosis to 378, liver function tests were normal except for mild elevation in alkaline phosphatase. CT scan of the abdomen/pelvis revealed necrotic perforated cholecystitis and no cholelithiasis.