A 75-Year-Old Hospitalized Man Is Evaluated for Abdominal Pain and Fever

A 75-year-old hospitalized man is evaluated for abdominal pain and fever.  The patient was admitted 2 weeks ago due to necrotizing fasciitis of the gluteal region and severe sepsis.  He has been treated with surgical debridements, intravenous antibiotics, and fluids.  For the past 2 days, the patient has had right upper quadrant abdominal pain, nausea, and recurrent fever.  He has a history of hypertension, type 2 diabetes mellitus, and chronic obstructive pulmonary disease.  His temperature is 38.8 C (102 F) .  Physical examination shows marked tenderness over the right subcostal area.  Leukocyte count is 18,000/mm³ compared to 9,600/mm³ 2 days ago.  Laparoscopic surgery is planned.  Which of the following will most likely be found during this patient's surgery?

A) Choledochal cyst
B) Fibrotic and shrunken gallbladder
C) Fluke infection of the biliary tree
D) Inflamed and enlarged gallbladder
E) Pigment gallstones
F) Porcelain gallbladder

Correct Answer:

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