A 53-year-old woman presents to the emergency department with severe epigastric pain radiating to her back for 10 hours. She reports multiple episodes of vomiting. Her medical history is significant for recurrent biliary colic. She does not take any medications. Temperature is 37.8°C (100.0°F), blood pressure is 110/68 mm Hg, pulse is 106/min, and respiratory rate is 20/min. Physical examination reveals epigastric tenderness to palpation without rebound or guarding. Laboratory studies show the following:
Abdominal ultrasonography demonstrates gallstones without common bile duct dilation.
Which of the following is the most appropriate management after initial stabilization with intravenous fluids?
The correct answer is:
C: Laparoscopic cholecystectomy during the same hospitalization.
This patient has gallstone pancreatitis. Once the acute episode has stabilized, cholecystectomy should be performed during the same hospitalization to prevent recurrent pancreatitis and other biliary complications. Delaying surgery significantly increases the risk of recurrence.
Answer choice A: Discharge home with outpatient follow-up, is incorrect.
Although symptoms may improve with supportive care, discharge without definitive management places the patient at high risk for recurrence.
Answer choice B: Elective cholecystectomy in one year, is incorrect.
This is a common management error. Current recommendations favor cholecystectomy during the index admission for mild gallstone pancreatitis.
Answer choice D: Long-term pancreatic enzyme replacement, is incorrect.
Pancreatic enzyme replacement is used for chronic pancreatic insufficiency rather than acute pancreatitis.
Answer choice E: Total parenteral nutrition, is incorrect.
Most patients with acute pancreatitis can resume enteral nutrition and do not require parenteral feeding.
Key Learning Point
Patients with mild gallstone pancreatitis should undergo cholecystectomy during the same hospitalization after clinical stabilization.
