An 89-year-old woman presented with acute nausea andepigastric pain. As part of her workup, abdominal ultrasound was performed which revealed gallbladder wallthickening, pericholecystic fluid, sludge, common bileduct dilatation of 12 mm, and peripancreatic fluid. Thesefindings were suggestive of biliary obstruction from acutepancreatitis. One year prior, she had a similar presentationbut was deemed a poor surgical candidate and underwentpercutaneous cholecystostomy drainage. On this admission, the patient was again considered unfit for surgeryon the basis of her age and severe dementia. A percutaneous cholecystostomy drain was again recommended,but her family declined this option.
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