American Board of Internal Medicine (ABIM) Certification Practice Exam

What should be performed on patients at unacceptably high risk for cholecystectomy?

1. Laparotomy with exploration

2. Percutaneous or endoscopically placed cholecystostomy tubes

3. Immediate cholecystectomy

4. Palliative care only

The correct answer is: Percutaneous or endoscopically placed cholecystostomy tubes

In patients who are at an unacceptably high risk for cholecystectomy, the primary goal is to manage their symptoms while minimizing surgical risk. One effective approach in this scenario is the placement of percutaneous or endoscopically placed cholecystostomy tubes. This procedure serves a dual purpose: it provides a means to drain the gallbladder, alleviating symptoms such as biliary colic or cholecystitis, while avoiding the potential complications associated with more invasive surgery in high-risk patients. Cholecystostomy tubes can help stabilize patients who may not be candidates for surgery due to significant comorbidities or other risk factors. In contrast, laparotomy with exploration is a much more invasive procedure typically reserved for urgent situations or when other interventions have failed. Immediate cholecystectomy would not be appropriate for those at high surgical risk, as it poses unnecessary risks to the patient. Lastly, limiting options to palliative care without addressing the underlying issue of gallbladder disease may lead to further complications and decreased quality of life, thus not providing a comprehensive solution. Therefore, placing cholecystostomy tubes is the best approach in this context, effectively managing the condition while prioritizing patient