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A correction has been published: N Engl J Med 2008;359(3):325.
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This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.
A previously well 42-year-old woman presents with severe pain in the right upper quadrant, which started 15 hours earlier. She has previously noted episodic pain in that location that lasted for up to 2 hours but has not sought medical advice. She has had one episode of vomiting with the current attack. On physical examination, her temperature is 38.5°C, and the heart
The Clinical Problem
Pathogenetic Features
Strategies and Evidence
Diagnosis
Imaging
Diagnosis and Grading
Treatment
Timing of Cholecystectomy
Antibiotic Therapy
Percutaneous Cholecystostomy
Guidelines
Areas of Uncertainty
Conclusions and Recommendations
Source Information
From the Section of Hepatobiliary–Pancreatic Surgery, Washington University in St. Louis and Barnes–Jewish Hospital, St. Louis.
Address reprint requests to Dr. Strasberg at Box 8109, 660 Euclid Ave., St. Louis, MO 63110, or at strasbergs@wustl.edu.
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