On opening the abdomen, there was no free fluid, odor or evidence of bowel ischemia. The iliotransverse anastomosis looked normal. Exploration of the right upper quadrant revealed gangrenous cholecystitis with pericholecystic fluid. The gallbladder was not walled off.
The gallbladder was removed retrograde until the cystic duct could be clearly identified. Anterior and posterior branches of the cystic artery were ligated at the infundibulum as they were encountered. Both branches were patent and actively pumping.
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