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T2-weighted image demonstrating a hypointense focus in the expected locations of valves of Heister, depicted by a red arrow.
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The MRCP performed in November 2017 showed a markedly distended, thin-walled gallbladder with a 1 cm gallstone lodged in the proximal cystic duct (Fig. 1).
Paucity of bowel gas in the upper abdomen, with suggestion of a large mass (distended stomach) displacing bowel loops inferiorly).
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Abdominal examination revealed epigastric fullness with a succussion splash (Fig. 2).
(a) Markedly distended gallbladder with ascites and compression of the duodenum. (b) Coronal section demonstrating the gallbladder mucocele and compression of the duodenum. Encapsulated small bowel loops with ascites can be appreciated in the left lower abdomen. The decompressed stomach with a nasogastric in-situ is visible in the upper abdomen.
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The small bowel loops were normal in caliber, but were unchanged in appearance and distribution compared to his last CT scan in March 2018 (Fig. 3a and b).
The patient's head is towards the top of the image. A right subcostal incision has been made and the abdomen entered. The distended gallbladder mucoele with firm white fibrous plaques can be appreciated coming into view with retraction of the small bowel loops inferiorly.
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The distended gallbladder was covered with firm white plaques, and a cholecystostomy was performed to allow decompression of the gallbladder with a suction apparatus to enable surgical manipulation of the gallbladder and better visualization of biliary anatomy (Fig. 4).