Vomiting, fever and abdominal pain since 2 weeks.
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A radiodense calculus is seen in gall bladder neck. Sloughing of mucosa of gall bladder wall with mild pericholecystic free fluid. Perigall bladder hepatic hyperemia, secondary to active inflammation. Reactive edema of C loop of duodenum and hepatic flexure of colon. Mild thickening of right anterior pararenal fascia.
Incidentally detected outpouching from the medial wall of C loop of duodenum proximal to ampulla with air fluid levels within. It is not exerting any significant mass effect on the intrapancreatic CBD to cause any upstream dilatation.
This is a case of acute calculous cholecystitis. The detection of a periampullary diverticulum was purely incidental. The demonstration of the periampullary diverticulum is helped by the on table administration of 200 to 250 ml of neutral oral contrast enabling good distension. As a routine in our institution, neutral contrast is administered in all conditions which require bowel imaging and distension.