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a) IV antibiotics and interval cholecystectomy
b) ERCP followed by laparoscopic cholecystectomy
c) Open cholecystectomy and common bile duct exploration
d) Laparoscopic cholecystectomy and intraoperative cholangiogram
e) Don't Know

2. Laparoscopic cholecystectomy is performed. Acute cholecystitis is found with a markedly edematous dilated gall bladder. Intraoperative cholangiogram is attempted but is unsuccessful. The patient is discharged the following day tolerating a regular diet. Three days later she presents in the Emergency Room with nausea, vomiting and epigastric pain. She has a low grade fever, and her LFT's are notable for a total bilirubin of 2.1, alkaline phosphatase of 180, SGOT of 75 and SGPT of 87. She is tender in the epigastrum. The differential diagnosis includes:

a) Cholangitis
b) Bile duct injury
c) Common bile duct stones
d) Any of the above
e) Don't Know

3. Which of the following tests is potentially useful in this patient's management?

a) Ultrasound
b) HIDA scan
c) ERCP
d) PTC
e) All of the above
f) Don't Know

a) Common bile duct injury
b) Right hepatic duct injury
c) Cystic duct stump leak
d) Drainage from ducts of Luschka
e) Accessory right hepatic duct injury
f) Don't Know

5. The optimal therapeutic maneuvers include: (multiple answers acceptable)

a) Laparotomy, drainage of biloma, T-tube placement
b) Laparoscopic drainage of biloma, identification and repair of bile duct injury
c) Nasal biliary drainage
d) Endoscopic sphincterotomy and transpapillary stent placement
e) CT or ultrasound guided percutaneous drainage of biloma