GI Radiography


Case 17 :
A 60-year-old male presented to the Emergency department with features suggestive of gastric outlet obstruction. Investigations into a previous attack of right hypochondrium pain and vomiting 3 weeks earlier had revealed impacted calculus at neck of gall bladder with sonographic features of acute cholecystitis. CT has been performed here. What is the differential diagnosis?

Click here for bigger picture

Click here for bigger picture

Click here for bigger picture

Fig 1   Fig 2   Fig 3  
________SCROLL FOR ANSWER__________






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

Dr Sanjeev Mani, Bandra Holy Family Hospital, Mumbai