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Gangrenous cholecystitis

Case contributed by Varun Babu
Diagnosis almost certain

Presentation

Tender hepatomegaly with fever spikes.

Patient Data

Age: 70 years
Gender: Male
ct

Overt distension of gall bladder with abnormal mural thickening and edema, a shaggy outline, discontinuity of the mucosa, pericholecystic fat stranding, and hyperemia of the adjacent liver parenchyma. Inferiorly, the wall has been breached with a small fluid collection (likely bile) causing secondary thickening of the hepatic flexure of the colon. No biliary dilatation and no liver abscess.

Case Discussion

These features are highly suggestive of gangrenous cholecystitis with a small localized perforation with a bile fluid collection arising from the fundus. 

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