PMC5465658_01
Coronal CT image showing a markedly distended and irregularly shaped intrahepatic gallbladder (red arrow) with surrounding edema.
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f1
It was difficult to distinguish where the gallbladder wall terminated and the hepatic parenchyma began, i.e., intrahepatic gallbladder (Fig. 1).
MR image (T2-weighted, axial) demonstrating marked thickening of the gallbladder wall and debris in the gallbladder (red arrow).
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f2
Magnetic resonance cholangiopancreatography confirmed a large hypo-enhancing gallbladder with multiple enhancing septations and thickened irregular wall, with invasion into the adjacent hepatic parenchyma as well as possible fistulization into the first portion of the duodenum/pylorus (Fig. 2).
Opening of the cholecystogastric fistula with purulence (red arrow); gastric antrum in the background.
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f3
Esophagogastroduodenoscopy demonstrated a cholecystogastric fistula through which the gallbladder was directly entered (Fig. 3).
Cholecystogastric fistula (left) and lumen of the gallbladder with exudative covering of wall (right).
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f4
A white exudate on the gallbladder wall and moderate purulence were noticed (Fig. 4).