Presentation
Patient presented with acute abdominal pain, vomiting (coffee ground) with hypotension. Echocardiography reveals pericardial effusion to rule out mesenteric ischemia.
Patient Data
The gallbladder is distended with irregular thinned out enhanced imperceptible wall more evident at the posterolateral aspect of its body with wall defect, however high attenuated gallbladder content seen continuous with pericholecystic fluid surrounding the gall bladder, extending to perihepatic and subhepatic regions with tracking of fluid into the paracolic gutter. High attenuated fluid collection suggestive of ? bile /blood.
Perisplenic free fluid collection noted as well. Inhomogenous attenuation of the related hepatic surface. Small paraumbilical hernia noted containing only omental fat. Scanned lung bases show mild pericardial effusion as well as mild pleural effusion slightly more on the right side.
Photo captured from video sent by operating surgeons.
Case Discussion
Operative intervention was done. Intra-operative findings (supplied by verbal communication with performing surgical team): the site of the gallbladder perforation was as described in the radiology report. The related surface of the liver has small laceration. A large amount of hemoperitoneum seen and pus drained out from the perforated gall bladder.
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