Radiological Case: Acute Perforated Acalculous Cholecystitis

Suraj Parekh, MD; Sherif Andrawes, MD; Christopher Giordano, MD; Richa Sharma, MD


Appl Radiol. 2018;47(2):20-23. 

In This Article

Case Summary

A 68-year-old male presented to the emergency department with worsening abdominal pain, which started four days prior. The pain was diffuse but more pronounced on the right side. Patient also complained of periodic non-bloody, non-bilious emesis for the past two days as well as subjective fever. On physical examination, he was afebrile with normal vital signs, had a soft, non-distended abdomen with tenderness to palpation in the right upper quadrant. There was no rebound or guarding. His labs revealed leukocytosis with a WBC of 16.3 and elevated total and direct bilirubin, 3.2 and 0.7 respectively. Alkaline phosphatase was within normal limits. Initial radiologic evaluation included a CT scan of the abdomen/pelvis and abdominal ultrasound.

On the following day, the patient was sent to Interventional Radiology for percutaneous cholecystostomy. Since his symptoms did not improve, the patient ultimately underwent open cholecystectomy where the gallbladder was noted to be distended with patches of necrosis and free purulent fluid. Gross pathology of the specimen demonstrated an enlarged gallbladder with diffusely hemorrhagic mucosa and areas of full thickness necrosis consistent with acute perforated gangrenous cholecystitis. Due to subsequent findings of post-operative bile leak, patient received an ERCP with CBD stent placement. Outpatient follow-up two months later showed no residual bile leak and clinically the patient's symptoms have resolved.