Perforated gallbladder

Case contributed by RMH Core Conditions

Presentation

RUQ pain, hypotensive.

Patient Data

Age: 73
Gender: Male
Modality: CT

The gall bladder mucosa shows interrupted enhancement and there is a localised perforation anteriorly close to the fundus. Associated pericholecystic fat stranding extending to the porta hepatus.

No intra or extrahepatic duct dilation. No GB stones visible (this does not exclude gall stones). No bile duct dilatation.

A hypodense lesion within the uncinate process of the pancreas, measuring 4.8 x 4.1 x 4.6 cm, has the appearance of a septated cystic mass. There are clear surrounding fat planes, and no vascular encasement. No further pancreatic lesions are identified, and the pancreatic duct is not dilated.

Conclusion:

  1. Acute cholecystitis with localised perforation. Unit notified.
  2. Mass within the uncinate process of the pancreas appears cystic. Differentials include a side branch intraductal papillary mucinous tumour, or less likely other cystic pancreatic tumour (assuming no recent pancreatitis).

 

Case Discussion

Acute cholecystitis is the most common cause of gallbladder perforation. It can also be iatrogenic, relating to cholecystectomy. 

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Case Information

rID: 29818
Case created: 25th Jun 2014
Last edited: 16th Dec 2016
Tag: rng
Inclusion in quiz mode: Included

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