Acute cholecystitis

Case contributed by Dr Luu Hanh

Presentation

Right upper quadrant pain, fever

Patient Data

Age: 50 years
Gender: Male
Ultrasound

Ultrasound demonstrates gallbladder wall thickening with a "laminated" appearance, pericholecystic fluid, sonographic Murphy sign, an obstructing stone in the gallbladder neck (not shown).

Asymmetrical wall thickness with ulceration (red arrow).

Ultrasound

Ultrasound guided percutaneous cholecystostomy

US-guided cholecystostomy was performed. Black and thick bile was obtained from gallbladder drainage.

 A cholecystectomy will perform some days later the presentation.

Courtesy of Dr Nguyen Van Cong

Case Discussion

US findings are consistent with acute cholecystitis. Especially, asymmetrical wall thickness with ulceration is suggestive of the gangrenous gallbladder.

Percutaneous cholecystostomy, which is a safe and effective procedure in high-risk patients was done until the stabilization of a patient to enable a more measured surgical approach.

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