Right-sided peritonism of short duration. No prior surgical history. Appendicitis?
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15mm defect in the anterior wall of the gallbladder. Locule of gas in the gallbladder lumen.
Pericholecystic fluid and inflammatory change and several locules of free gas in the right upper quadrant. A small volume of fluid tracks along the right paracolic gutter into the pelvis.
6 x 2cm wall enhancing perihepatic collection along the lateral aspect of the liver.
Prominent CBD. Small simple hepatic and renal cysts.
Right basal consolidation and small pleural effusion.
Gallbladder perforation is thankfully relatively rare. Even when it occurs the hole in the gallbladder wall may be subtle.
In this case, the defect in the wall is large and the locules of gas in the gallbladder lumen and surrounding peritoneal cavity suggest this resulted from emphysematous cholecystitis.
The patient proceeded to a laparotomy.