Enhancing surgical decision-making: the critical need for structured ultrasound training in residency. A case report of acute necrotic cholecystitis

Acute necrotic cholecystitis (ANC), marked by gallbladder wall necrosis, carries high morbidity if diagnosis and treatment are delayed. Ultrasound is the first-line imaging for suspected cholecystitis, but its sensitivity for necrosis is limited. This case underscores the value of surgical ultrasound competency in emergency decision-making. A 57-year-old woman with diabetes, asthma, and hypothyroidism presented with severe epigastric pain and systemic inflammation. Emergency ultrasound showed gallbladder wall thickening, pericholecystic fluid, and gallstones. CT confirmed necrosis with possible microperforation. An informal ultrasound by surgical residents later that day identified microperforations, expediting the decision for subtotal laparoscopic cholecystectomy. Surgery was successful, and recovery was uneventful. Ultrasound, when performed by trained surgical teams, enables rapid diagnosis and management of complex cholecystitis. Structured ultrasound training during residency could enhance diagnostic accuracy, reduce treatment delays, and improve outcomes in acute surgical emergencies.