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.

10 months prior

CT

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

3 weeks after PET CT

Ultrasound

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.

After ultrasound

MRI

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.

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