History of Illness:

A 43 year old woman suffered occasional attacks of pain in the right upper quadrant (RUQ) of the abdomen, together with intolerance of fatty foods for 15 years. In the last 10 months she had experienced episodes of nausea and epigastric pain, radiating to the right shoulder blade. At no stage was she jaundiced. In the 24 hours prior to admission to hospital, she developed severe pain in the upper abdomen, associated with high fever.

On examination, she was hypotensive (blood pressure 80/50) and mildly jaundiced. There was tenderness and rigidity in the right upper quadrant of the abdomen; An ultrasound examination of the RUQ of the abdomen revealed obstruction of the gallbladder outlet by an impacted gallstone; Blood cultures confirmed Gram-negative septicaemia secondary to acute-on-chronic cholecystitis (inflammation of the gallbladder). She was treated in intensive care, but despite all efforts at resuscitation, she died 2 days later.