GI Radiography

Imaging Findings

CT revealed a dilated gall bladder with a fuzzy posterior wall, and ill-defined fat planes around the gall bladder. Calculi are seen within. Cystic non-enhancing lesions are noted in the liver. A rim-enhancing cystic lesion is seen compressing the pylorus and duodenal bulb. A differential diagnosis of pseudocyst / collection / infected hydatid cyst was suggested (the latter in view of the liver lesions).

Diagnosis:

Operative findings revealed a gangrenous gallbladder, with necrotic walls, and
pericholecystic collection extending to the duodenal bulb.

Discussion:

Common complications of acute calculous cholecytitis include empeyma, peri-cholecystic collections, Mirrizi's syndrome, and fistulas. Post-cholecystitis collections seen in the Morrison's pouch, subhepatic region, or near the gall bladder fossa are not uncommon. Patient has presented predominantly with features of gastric outlet obstruction following the acute attack of cholecystitis. This is an unusual presentation of a complication of acute cholecytitis