PMC5536151_01
Preoperative ultrasound shows cholelithiasis.
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Ultrasound demonstrated a gallstone measuring 1 cm by 3 cm and some fatty liver changes however no evidence of wall thickening, pericholecystic fluid, or ductal dilation (Figure 1).
Preoperative CT abdomen with cholelithiasis and duodenal wall thickening.
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CT abdomen and pelvis with IV contrast demonstrated cholelithiasis as well as thickening of the duodenum and fluid adjacent to the pancreas (Figure 2).
Preoperative HIDA scan shows normal filling.
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HIDA scan was performed that demonstrated normal filling of the gallbladder as well as spillage into the small bowel (Figure 3). However due to continued unremitting abdominal pain and leukocytosis, a laparoscopic cholecystectomy was performed under general anesthesia.
CT abdomen demonstrating subcapsular collection.
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CT abdomen and pelvis with IV and oral contrast revealed a small subhepatic fluid collection unsurprising in light of recent surgery; however there was additionally a new subcapsular fluid collection measuring approximately 15 HU (Figure 4).
CT guided percutaneous drainage of subcapsular collection.
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An 8.5 Fr pigtail drainage catheter was inserted under local anesthesia under CT guidance by interventional radiology (Figure 5).
Percutaneous pigtail catheter drainage.
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Over a liter of bilious fluid was drained upon placement (Figure 6) and 100 cc the following day, which gradually deceased until there was no drainage from the pigtail catheter.