Presentation
History of laparoscopic cholecystectomy with recent attacks of right upper abdominal pain and obstructive jaundice.
Patient Data
There is a fluid-filled cystic structure at the gallbladder (GB) bed continuous with the cystic duct keeping with GB remnant. A tiny filling defect is seen inside the GB remnant and related mild edema is also noted.
The common bile duct (CBD) is dilated. Another tiny filling defect similar to the one seen at the GB remnant is seen at the distal end of CBD.
There is mild dilatation of the intrahepatic biliary radicles.
Complementary ultrasound examination confirmed the presence of GB remnant with a stone inside measuring 0.4 cm as well as a rim of fluid at the GB bed in association with tenderness on probing representing sonographic Murphy sign.
Annotated MR image showing the GB remnant stone and the distal CBD stone.
Case Discussion
This case represents gallbladder remnant with a tiny stone inside, positive sonographic Murphy sign and related mild edema denoting associated inflammation (gallbladder remnant cholelithiasis and cholecystitis). CBD is dilated with a tiny stone at its end which is explaining the presentation of the patient with obstructive jaundice.
Patients presenting with post-cholecystectomy upper abdominal quadrant pain should be suspected for gallbladder remnant as a result of incomplete surgical excision.