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Case of the Month

July 2015

Patient Data: Female patient 86 years old

Clinical Info: Very sick patient with pain in the right upper abdomen and raised infection parameters

There is an abnormal echogenic anterior wall of the gallbladder is this air or calcium?

The echogenic wall causes artefacts seen with air. There are also some small gallstones visible

Transverse image. There is some fluid around the gallbladder

There are also some stones

If it is air this is probably an emphysematous cholecystitis. Always look for a perforation. Patients with an emphysematous cholecystitis have a high risk of getting a perforation

Another image showing some fluid around the gallbladder and a gallbladderwall defect and possibly some airbubbles outside the gallbladder

Detail of the stones and sludge in the gallbladder There is also a small defect in the gallbladderwall

This is a CT scan of another female patient who is 70 years old who has abdominal pain and air in the gallbladder. The gallbladder is completely filled with air. Is this also an emphysematous cholecystitis

This is a CT image showing air in the intrahepatic bile ducts

This CT scan shows air in the common bile duct

This is an image of her gallbladder a year before. She had not been operated and did not have an ERCP

There is a large stone measuring more than 5,5cm. and thickened bile in the gallbladder

Transverse image of the gallbladder

This is again a CT image taken at a lower level showing dilatated small bowel loops. Can you guess what has happened

This is a CT image of the dilatated small bowel and the obstructing gallstone, which had perforated to the digestive tract and because of its size had caused a bowel obstruction.

61847-Mijn_Film_1.swf CT

61848-Mijn_Film_2.swf CT

61849-Mijn_Film_3.swf CT

Air in the gallbladder can have several reasons. The first patient had an emphysematous cholecystitis. A percutaneous drainage procedure was performed by us and the patient recovered well.
The second patient had a gallstone perforation to the digestive tract with bowel obstruction, and was operated by the surgeon.
Beware of another common reason of air in the gallbladder and bile ducts namely an ERCP and papillotomy.

For more cases of emphysematous cholecystitis and gallbladder perforation see

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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