Occult Perforated Gangrenous Gallbladder Found on Magnetic Resonance Cholangiopancreatography

Division

South Atlantic

Hospital

Grand Strand Medical Center

Document Type

Case Report

Publication Date

6-19-2021

Keywords

perforated gallbladder, gangrenous cholecystitis, cholecystectomy, necrotic gallbladder, occult perforated gallbladder, cholecystitis, liver ultrasound, magnetic resonance cholangiopancreatography (mrcp), computed tomography, atypical abdominal pain

Disciplines

Digestive System Diseases | Internal Medicine

Abstract

Acute gangrenous cholecystitis is a life-threatening disease that is most often diagnosed intraoperatively and can be missed on mildly symptomatic patients without the proper imaging modality. We present a case of a 69-year-old male with a history of hypertension, hyperlipidemia, and type 2 diabetes, and a recent right pontine infarct that arrived with 3 out of 10 right-sided abdominal pain. His liver ultrasound and computed tomography (CT) with contrast demonstrated acute cholecystitis. He was initially worked up conservatively and was scheduled for an elective cholecystectomy per surgery recommendation. However erring on the side of caution, the medical team had ordered a magnetic resonance cholangiopancreatography (MRCP), which demonstrated perforated gangrenous cholecystitis. Of note, the imaging modalities were ordered within a 24-hour window. The patient’s antibiotics were promptly broadened, and he was emergently sent to the operating room. Moving forward, we will identify atypical clinical presentations of gangrenous cholecystitis and consider ordering an MRCP when clinical suspicion remains high and initial imaging is inconclusive. Perforated gangrenous cholecystitis is a severe disease and can cause rapid demise if not identified and treated early.

Publisher or Conference

Cureus

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