Perforation of the gallbladder with communicating pericholecystic abscess: ultrasonographic diagnosis.

A 75-year-old male patient with recurrent biliary colics attends the emergency service because of right upper-quadrant abdominal pain and fever for two days. The patient experiences pain when palpated on the right hypochondrium, with Murphy’s sign and a temperature of 38 oC. Laboratory studies revealed leukocytosis with neutrophilia (15,000 leukocytes/mm3, 80% neutrophils) with hepatic enzymes and normal pancreatic amylase. An initial ultrasound exam was performed, which showed evidence of acute cholecystitis with distended gallbladder, cholelithiasis, sludge, and diffuse thickening of the gallbladder wall (Fig. 1). Adjacent to the gallbladder a heterogeneous collection compatible with an abscess was seen, which communicated with the gallbladder through a break on the wall that was interpreted as a gallbladder perforation with communicating pericholecystic abscess (Fig. 2). Abdominal contrast-enhanced CT confirmed the pericholecystic abscess, the thickening of the gallbladder wall, and an infundibular gallstone. A dilation of the distal common bile duct could also be seen. The perforation of the gallbladder wall was not demonstrated by means of this procedure (Fig. 3). The patient, waiting for elective surgery, was treated with antibiotics, which improved the patient’s clinical condition.