Gallbladder perforation

Case contributed by Dr Mostafa El-Feky

Presentation

Right hypochondrial pain and jaundice.

Patient Data

Age: 70 years
Gender: Male
MRI

MRCP

The gallbladder shows diffuse wall thickening and two related perforations, one intrahepatic through gall bladder bed with related intrahepatic collection measuring 4 x 2 cm and the other collection is anteriorly at the left infrahepatic space measuring 4.8 x 2.5 cm, anterior to the pancreatic head and CBD abutting the pylorus, 1st and 2nd parts of duodenum, surrounded by mild perifocal edema. No current evidence of cholecystoenteric fistulation.

The common bile duct is dilated reaching 11 mm with distal end stone measuring about 1.2 x 0.6 cm with associated moderate intrahepatic biliary radicals dilatation. The common bile duct is gently splayed by the infrahepatic collection.

Incidentally noted left hypochondrial abdominal wall lipoma expanding the fibers of the left external oblique muscle representing intramuscular lipoma.

Case Discussion

The radiological features are representing a case of obstructive jaundice by a distal common bile duct stone. Extrahepatic obstructive jaundice leads to increased biliary pressure and consequently inside the gallbladder lumen, which can lead to vascular compromise at the gallbladder wall and ultimately to necrosis and perforation. This is considered as type 2 according to Neimeier classification of gallbladder perforation.

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Case information

rID: 65651
Published: 17th Jan 2019
Last edited: 21st Jan 2019
Inclusion in quiz mode: Included
Institution: Dar El Ashaa Center

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