Sonographic diagnosis of gallbladder perforation

Autor: Pasteur Rasuli, Majed Ashour, Bernard J. Lewandowski, Mohammed A. Neimatullah
Rok vydání: 1998
Předmět:
Zdroj: Journal of Ultrasound in Medicine. 17:389-391
ISSN: 0278-4297
DOI: 10.7863/jum.1998.17.6.389
Popis: A 71 year old man came in with fever, right upper quadrant pain, and abdominal distention 2 days after a coronary artery bypass graft. Clinical examination revealed mild right flank tenderness, and an abdominal plain film appearance was consistent with ileus. Laboratory studies showed a white blood cell count of 14.4 × 103/mm3, with blood and urine cultures positive for bacteria. In spite of adequate antibiotic treatment, fever and abdominal pain persisted, and the leukocytosis increased to 19.1 × 103/mm3, so ultrasonography of the abdomen was performed. Sonography of the abdomen revealed a large amount of ascites, with an echogenic fluid collection in the right subdiaphragmatic region (Fig. 1). The gallbladder showed multiple calculi and a large defect in the fundus, the “hole sign,” with echogenic material projecting into and out of the gallbladder lumen (Figs. 2, 3); several calculi were detected within the fluid in the cul-de-sac (Fig. 4). The sonographic diagnosis was acute free gallbladder perforation with bile peritonitis and migration of a gallstone into the peritoneal cavity, with a possible right subdiaphragmatic abscess. The patient underwent open cholecystectomy. At surgery, the operative findings were a 2.5 × 0.5 cm perforation at the fundus, with adherent green exudate, cholelithiasis, gallstones in the peritoneal cavity in the pelvis, 1.5 liters of bile ascites, and a right subdiaphragmatic abscess.
Databáze: OpenAIRE
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