RUQ pain, hypotensive.
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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.
- Acute cholecystitis with localised perforation. Unit notified.
- 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).
Acute cholecystitis is the most common cause of gallbladder perforation. It can also be iatrogenic, relating to cholecystectomy.