Presentation
Right hypochondrium pain and fever.
Patient Data
The gallbladder is contracted and shows multiple small hyperdense calculi. Mild diffuse heterogeneously enhancing gallbladder wall thickening was seen. The gallbladder wall has a tiny focal discontinuity along its superior aspect with resultant hypodense collection in segment V/VIII of the liver. The gall bladder has adhered to the adjacent liver, 1st part of the duodenum, and the hepatic flexure of the large bowel with a possible fistulous tract between the gallbladder and hepatic flexure of the large bowel.
Impression: Overall imaging findings are in favor of chronic calculus cholecystitis with perforation and localized hepatic collection, However, the remote possibility of neoplastic etiology cannot be ruled out completely.
There is a focal discontinuity in the gall bladder wall with a hepatic collection.
Possible cholecystocolonic fistula.
Case Discussion
The intraoperative finding was a contracted gallbladder with the necrotic wall, calculi, intrahepatic pus pocket, and possible cholecystocolic fistula.
The histopathological report shows a feature of chronic cholecystitis with caseating granulomas, however, acid fast bacilli were not identified. Dysplasia or malignancy not seen.
In a developing country like India, the above findings are likely due to gallbladder tuberculosis associated with cholelithiasis.
Gallbladder tuberculosis is a rare type of abdominal tuberculosis.
Co-authors:
Dr. Gaurav Kumar, MBBS,DNB (General surgery)
Dr. Imranul Haque, MD (Pathology)
Dr. Manish Kumar, MD (Biochemistry)