Retained gallstone

Case contributed by Eric F Greif

Presentation

Persistent right sided abdominal pain status post cholecystectomy about 1 year ago.

Patient Data

Age: 50 years
Gender: Male
ct

Post cholecystectomy clips and biliary catheter are noted. There are small focal round/oval densities in the hepatorenal recess (Morison's pouch), slightly hyperdense compared to the liver.

Annotated image

Small focal round/oval densities in the hepatorenal recess (yellow arrows) which are slightly hyperdense compared to the liver. These represented retained (dropped) gallstones, which was confirmed at surgery.  

mri

There are a couple of adjacent focal T1 hyperintensities in the hepatorenal recess, with corresponding T2 hypointensity.

Evidence for post cholecystectomy. Common bile duct catheter is noted.

Annotated image

There are a couple of adjacent focal T1 hyperintensities in the hepatorenal recess, with corresponding T2 hypointensity (yellow arrows), representing retained (dropped) gallstones, which was confirmed by surgery.

Case Discussion

The patient was status post cholecystectomy about one year ago and had continued right abdominal pain. Multiple follow up abdominal CT's were performed in which there was no mention of the retained gallstones. Eventually, an abdominal MRI was performed in which a presumed diagnosis of retained gallstones was made. This was confirmed by surgical exploration and removal of the stones.

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