PMC5081238_01
Photograph of the abdomen of the patient, showing external opening of the fistula (arrow) overlying an old laparotomy scar (arrow heads) and erythema of the surrounding skin (double arrow).
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On local examination, a discharging sinus was seen in the epigastrium near the midline, overlying an old laparotomy scar (Figure 1). Erythema was seen in the surrounding skin (Figure 1).
Contrast-enhanced axial CT showing the fundus of GB reaching up to the anterior abdominal wall. There is marked thickening of the GB wall (arrows). A calculus is also seen in the lumen of GB (arrow head).
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On CT, the gall bladder (GB) was found to be well distended and the fundus of GB was reaching up to the anterior abdominal wall in the midline (Figure 2). There was concentric thickening of the wall of GB measuring up to 13 mm, showing heterogenous enhancement (Figures 2-4). Multiple rounded hyperdense calculi were seen in the lumen of GB (Figures 2, 5).
Coronal reformatted contrast-enhanced CT showing multiple air-density foci in IHBRs (horizontal arrows) suggestive of pneumobilia. Breach in the mucosal lining of GB is also seen (vertical arrow). There is concentric thickening of the GB wall showing inhomogeneous enhancement (arrow heads).
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There was concentric thickening of the wall of GB measuring up to 13 mm, showing heterogenous enhancement (Figures 2-4). A defect of approximately 9 mm in size was seen in the wall of GB (Figures 3, 5) and a small fluid collection was observed in the peri-cholecystic area near the defect, measuring approximately 36x25 mm (Figure 5). However, air-density foci were seen in IHBR, suggestive of pneumobilia (Figure 3).
Sagittal reformatted contrast-enhanced CT showing GB fundus adherent to the anterior abdominal wall with ulceration of the overlying skin (long arrow). There is concentric thickening of the GB wall showing inhomogeneous enhancement (small arrows).
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There was concentric thickening of the wall of GB measuring up to 13 mm, showing heterogenous enhancement (Figures 2-4).
Contrast-enhanced axial CT showing a heterogeneously-enhancing thickened GB wall with small peri-cholecystic fluid collection (double arrow) adjacent to a small defect in the GB wall (long vertical arrow). Linear fistula tract is seen extending from the GB fossa to skin (small arrows). Hyperdense calculus is also noted in the lumen of GB (arrow head).
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Multiple rounded hyperdense calculi were seen in the lumen of GB (Figures 2, 5). A defect of approximately 9 mm in size was seen in the wall of GB (Figures 3, 5) and a small fluid collection was observed in the peri-cholecystic area near the defect, measuring approximately 36x25 mm (Figure 5). A fistulous tract was seen as a fluid-density streak extending from the peri-cholecystic area to the anterior abdominal wall and skin (Figure 5).