LAUSR

Omphalocele is a congenital abdominal wall defect at the umbilicus, which can contain variable amounts of abdominal organs covered in peritoneum. We present a 34-year-old woman with a history of an incompletely repaired omphalocele with recurrent small-bowel obstructions and lung hypoplasia, complicated by chronic respiratory failure requiring nocturnal noninvasive ventilation. She presented with a 5-day history of right upperquadrant abdominal pain, which was associated with focal abdominal distention and overlying erythema (Fig. 1). Her vital signs were notable for fever and tachycardia, and laboratory test results showed leukocytosis. She was initially referred to our hepatobiliary surgery team. MRCP showed a distended gallbladder with circumferential wall thickening and pericholecystic fluid consistent with