Presentation
Abdominal pain and distension.
Patient Data
Axial and coronal reformatting post intravenous contrast study shows a large subcapsular hepatic collection. The gall bladder is distended with two sites of wall defect seen in its anterior and posterior parts these defects are look connected to the subcapsular hepatic collection. Small dens foci seen in the region of Morison's pouch similar to the stones seen in the gall bladder suggesting to be a dropped gall stones.
Selected series of annotated images show the gall bladder defects follow the turquoise dotes to see the anterior defect, follow the red dotes to see the posterior defect through which the stones had been dropped. Another image shows the site of dropped gall stones (orange arrows).
Case Discussion
Gastrojejunostomy had been done for this patient for relieving a benign gastric outlet obstruction. A few months later, the patient developed gradually increased abdominal pain and distention. CT scan revealed defects in gall bladder in two sites with a related nearby collection and dropped gall stones. Bilateral pleural effusion and right side PUJ are noticed.
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