Which symptom is less likely to be present in patients experiencing gangrenous cholecystitis?

In gangrenous cholecystitis, the condition typically develops when there is an obstruction of the cystic duct along with compromised blood supply to the gallbladder, leading to the death of gallbladder tissue. The classic presentation of cholecystitis usually includes symptoms such as fever, abdominal pain, and nausea.

Murphy’s sign, which is a clinical test where a patient experiences pain upon palpation of the right upper quadrant while taking a deep breath, is strongly associated with acute cholecystitis due to its inflammatory nature. However, in cases of gangrenous cholecystitis, the inflammatory response may be less pronounced as the necrosis of the gallbladder tissue can lead to a blunting of the usual signs of inflammation. Therefore, patients may not exhibit Murphy’s sign reliably, as there could be diminished tenderness or a lack of typical guarding reflexes due to widespread tissue necrosis.

In summary, while fever, abdominal pain, and nausea are all common symptoms of cholecystitis, the presence of Murphy's sign is less likely in the setting of gangrenous changes, making it the most appropriate answer in this context.