Sonographic diagnosis of gallbladder perforation
| Autor: | Pasteur Rasuli, Majed Ashour, Bernard J. Lewandowski, Mohammed A. Neimatullah |
|---|---|
| Rok vydání: | 1998 |
| Předmět: |
Male
Abdominal pain medicine.medical_specialty Gallbladder disease Subdiaphragmatic Abscess Gallbladder Diseases Gallbladder perforation Cholecystitis medicine Humans Radiology Nuclear Medicine and imaging Aged Ultrasonography Rupture Spontaneous Radiological and Ultrasound Technology business.industry Gallbladder Gallstones medicine.disease Surgery medicine.anatomical_structure Acute Disease Abdomen Radiology medicine.symptom business |
| 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 |
| Externí odkaz: |
|
Plný text