Item 262
A 21-year-old woman undergoes open cholecystectomy for acute cholecystitis. The cholangiogram shown is obtained. Common bile duct exploration with choledochoscopy fails to remove impacted stones in the ampulla of Vater.
The most appropriate next step would be
placement of a T-tube
immediate endoscopic retrograde cholangiopancreatogram and sphincterotomy
transduodenal sphincteroplasty
choledochojejunostomy
infusion of chenodeoxycholic acid into the common bile duct
For the incomplete statement above, select the one completion that is BEST of the 5 given.
For the critique of item 262 see page 397.
Footnotes
(Reproduced by permission from SESAP’96–’98 Syllabus Surgical Education and Self-Assessment Program, Volume 1, 9th edition. For enrolment in the Surgical Education and Self-Assessment Program, please apply to the American College of Surgeons, 55 East Erie St., Chicago, IL 60611, USA.)