Subacute pericholecystic abscess

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Chronic recurrent right upper quadrant pain abdomen in a veteran.

Patient Data

Age: 65 years
Gender: Male
Nuclear medicine

Metabolically active gallbladder with gallstone and recommend ultrasound/hepatobiliary scan to evaluate for acute on chronic calculous cholecystitis.

The gallstone has moved from the neck to the fundus of the gallbladder. The mass does not move and so a metabolically active focal gallbladder lesion likely that is inflammatory in nature.

CT

10 months prior

10 months prior to PET C, the large gallstone was in the neck of the gallbladder.

Ultrasound

3 weeks after PET CT

There is a large gallstone, thickened and ill-defined gallbladder wall. This study is 3 weeks after the PET CT. There is a small pericholecystic fluid collection adjacent to the gallbladder and liver.

MRI

After ultrasound

MRCP showing large stone in the neck of the gall bladder. There is a fluid collection adjacent to the gallbladder - likely a tiny rupture with pericholecystic fluid collection and abscess. No choledocholithiasis.

Case Discussion

The patient underwent laparoscopic surgical cholecystectomy confirming a pericholecystic abscess, extensive adhesions, chronic cholecystitis with mucosal erosions. JP drain was left in place. He was discharged home on antibiotics postoperatively. Do not take comfort that a large gallstone will not cause trouble.

PlayAdd to Share

Case information

rID: 68313
Published: 24th May 2019
Last edited: 30th May 2019
Inclusion in quiz mode: Included
Institution: Augusta University

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.