A patient has persistent abdominal pain, fever, and nausea several days after laparoscopic cholecystectomy. The best next step in management to identify the source of the problem is which imaging study?

A patient has persistent abdominal pain, fever, and nausea several days after laparoscopic cholecystectomy. The best next step in management to identify the source of the problem is which imaging study?

• A. Ultrasound of the abdomen
• B. CT scan of the abdomen
• C. MRCP
• D. Hepatobiliary scintigraphy (HIDA) scan

Answer: (B)

A contrast-enhanced CT scan of the abdomen is the best initial imaging choice when a patient has persistent abdominal pain, fever, and nausea several days after laparoscopic cholecystectomy because it quickly surveys the entire abdomen for a range of postoperative complications. CT can reliably identify fluid collections or abscesses, signs of leakage from the biliary system or bowel, free air, and other intra-abdominal problems, guiding management such as drainage or surgery. Ultrasound has limited sensitivity for deep intra-abdominal issues and can be hindered by gas and postoperative changes, making it less reliable for locating an abscess or a leak in this context. MRCP focuses on biliary anatomy but is not ideal for acute post-op complications or broad source localization. A HIDA scan is excellent for detecting biliary leaks specifically, but it’s more targeted and slower, whereas CT provides a comprehensive view to pinpoint the problem quickly and plan the next steps.

A contrast-enhanced CT scan of the abdomen is the best initial imaging choice when a patient has persistent abdominal pain, fever, and nausea several days after laparoscopic cholecystectomy because it quickly surveys the entire abdomen for a range of postoperative complications. CT can reliably identify fluid collections or abscesses, signs of leakage from the biliary system or bowel, free air, and other intra-abdominal problems, guiding management such as drainage or surgery.

Ultrasound has limited sensitivity for deep intra-abdominal issues and can be hindered by gas and postoperative changes, making it less reliable for locating an abscess or a leak in this context. MRCP focuses on biliary anatomy but is not ideal for acute post-op complications or broad source localization. A HIDA scan is excellent for detecting biliary leaks specifically, but it’s more targeted and slower, whereas CT provides a comprehensive view to pinpoint the problem quickly and plan the next steps.