Presentation
Right-sided abdominal pain.
Patient Data
Gallbladder dilatation with stones and sludge in the gallbladder fundus. Gallbladder wall thickening, areas of increased and decreased enhancement, and irregularity with multiple areas of discontinuity. Several small contained extraluminal collections which project from defects in the gallbladder wall. No intraluminal or intramural gas. Mild associated pericholecystic inflammation. Few vague ill-defined low-attenuation areas along the anterior aspect of segment IVB/V, which are likely related to focal fat or inflammation.
Pathology report:
Gross: Received in formalin are 7 fragments of tissue consistent with portions of gallbladder which measure from 3.0 x 1.5 x 0.2 cm to 9.5 x 6.2 x 0.4 cm. The mucosa has greenish-brown exudate and areas of erosion. Cut section shows areas of necrosis. The gallbladder wall measures up to 1.3 cm in thickness. Also, present within the container are numerous gravel-like gallstones measuring from less than 0.1 to 0.4 cm. Several stones are lodged at the cystic duct.
Diagnosis:
Gallbladder, cholecystectomy:
- Gangrenous acute and chronic cholecystitis.
- Cholelithiasis.
Case Discussion
Gangrenous or necrotizing cholecystitis is a severe form of acute cholecystitis resulting in ischemic necrosis of the gallbladder wall. It has higher morbidity and mortality, generally occurring in older patients.
The key imaging featuring differentiating acute uncomplicated cholecystitis from gangrenous cholecystitis are:
- gas in the wall or lumen
- intraluminal membranes
- irregular or absent wall
- irregular wall enhancement
- pericholecystic abscess
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