Acute cholecystitis with colonic pseudo-obstruction

Case contributed by Dr David Tunchon

Presentation

Known T3N0M1 sigmoid adenocarcinoma. Presented with 10 days of diarrhoea, lethargy, decreased oral intake, nausea with vomiting, sensation of increasing abdominal pressure. No associated fevers.

Patient Data

Age: 75
Gender: Male

Distended large bowel to the level of a previous sigmoid anastomosis. Small bowel of normal calibre. 

Multiple lesions of low density throughout splenic and hepatic parenchyma consistent with metastatic disease.

Diffuse gall bladder wall thickening with pericholecystic and perihepatic free fluid, consistent with expected imaging features of acute cholecystitis.

Case Discussion

Clinical correlation of imaging findings suggested that the patient was suffering from colonic pseudo-obstruction which self-resolved. Interestingly, the imaging findings of acute cholecystitis were completely unexpected given that the patient had relatively unchanged liver function tests and the patient did not display clinical examination findings consistent with acute cholecystitis. The patient underwent laparoscopic cholecystectomy.

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Case information

rID: 54707
Case created: 24th Jul 2017
Last edited: 28th Jul 2017
Inclusion in quiz mode: Included

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