Ceftriaxone excretion into gallbladder

Case contributed by Mostafa El-Feky


Upper respiratory tract infection with associated abdominal pain and a week ago with given history of US showing normal gall bladder and mesenteric adenitis before treatment . Treatment with ceftriaxone was made, currently came for follow up US.

Patient Data

Age: 7 years
Gender: Female

US abdomen


The gallbladder shows normal wall thickness with a contracted lumen. The lumen shows homogenous echogenic content completely casting its lumen. 

Multiple reactive mesenteric lymph nodes with a preserved oval-shape and intact outline (mesenteric adenitis).

Case Discussion

Considering the given history of ceftriaxone therapy, the newly appearing echogenic gallbladder contents is attributed to biliary excretion of ceftriaxone (gallbladder pseudolithiasis). Follow up is recommended to confirm if this resolves or persists, which can be a nidus for gallstones. Ceftriaxone also could affect the contractility of the gallbladder. The abdominal pain is most likely due to mesenteric adenitis in this case.

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