PMC4531617_01
Abdominal ultrasonography on the 1st admission shows distended gallbladder with internal debris and sludge materials.
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On the 2nd day of admission, abdominal ultrasonography revealed echogenic sludge materials within the distended gallbladder with no gallstone (Figure 1).
Abdominal CT on the 1st admission shows diffuse thickening of gallbladder wall and about 2cm sized highly-attenuated materials (arrow).
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On the 3rd day of admission, abdominal CT scan showed diffuse thickening of the gallbladder wall, high attenuated materials with a diameter of 2 cm and focal inflammatory stricture at the level of the common hepatic duct (Figure 2).
ERCP shows diffuse segmentally dilated Lt. IHD and slightly narrowed distal CHD (arrow). There is no filling defect in CBD and GB was invisible.
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The gallbladder was not seen and no evidence of choledocholithiasis was present (Figure 3).
Endoscopy shows a round shallow ulcer base with blood oozing at the junction of the 1st and 2nd part of duodenum.
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The bleeding ceased after the injection of 1:1000 epinephrine (Figure 4).
Abdominal US shows eccentric wall-thickening of anterior wall of GB and there was echogenic mass filling the GB lumen. Air trapping in the anterior wall of GB and biliary tract is also seen.
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The abdominal ultrasonography taken on the 13th day of the 2nd admission has shown significantly thickened anterior wall of the gallbladder with echogenic mass (Figure 5).
GB biopsy findings. (A) Microscopy shows diffuse epithelial hyperplasia with partially high-grade dysplasia on GB neck (arrow) (H&E, x40). (B) Microscopy shows focal areas of carcinomatous change on GB neck (H&E, x100). (C) Microscopy shows acute nonspecific suppurative inflammation on GB fundus. (H&E, x40).
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The histologic finding was compatible with acute nonspecific suppurative inflammation, as most of the mucosae were detached with a partially high grade dysplastic change in the neck of gallbladder and focal superficial carcinomatous invasion into the muscle layers (Figure 6A, 6B, 6C).