Presentation
Right upper quadrant pain and elevated bilirubin.
Patient Data
The gallbladder is distended and has a thickened wall, measuring up to 6 mm. A focus of wall discontinuity is noted near the gallbladder fundus (IM: 54) and pericholecystic fluid is noted. Multiple gallstones identified and stone is within the dilated cystic duct. No intrahepatic biliary dilatation. The common biliary duct is not abnormally distended. The liver has diffuse increased echogenicity in keeping with fatty infiltration. No hepatic focal lesions. The imaged pancreas has a normal sonographic appearance.
Case Discussion
Gallbladder perforation is an uncommon complication related to cholecystitis. This diagnosis was achieved based on the clinically and sonographic features of acute cholecystitis, with the presence of pericholecystic fluid and subtle layering of the gallbladder wall with a well-defined focus of wall discontinuity.