PMC5752216_01
Shows a contracted gallbladder containing stones.
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Computed tomography (CT) of the abdomen revealed a contracted, thick gallbladder containing stones and few gas bubbles (Fig. 1, Fig. 2).
Shows an area of inflammatory reaction between the hepatic flexure and the gallbladder (arrow).
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Presence of cholecystocolonic fistula was suspected but no clear fistulous communication could be identified (Fig. 3).
Hepatobiliary Imino-Diacetic Acid (HIDA) scan shows "no filling" of the gallbladder.
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After 5 days of persistent abdominal distension and diarrhea we proceeded with obtaining a Hepatobiliary Imino-Diacetic Acid (HIDA) scan to visualize any fistulous communication between the hepatic flexure and colonic flexure HIDA scan did not reveal any filling of the gallbladder and suggested occlusion of the systic duct (Fig. 4).
Endoscopic Retrograde Cholangiography (ERC) shows abrupt cessation of contrast flow in the cystic duct (arrow) with no contrast flow into the gallbladder. The rest of the biliary tree is patent with free flow of contrast.
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The cystic duct was completely occluded and neither a fine wire nor contrast could pass beyond the site of obstruction (Fig. 5).