Widened gall bladder without emptying, thickening of the gall bladder wall with increased echogenicity. Depiction of a concrement giving an acoustic shadow at the transition to the cystic duct.

Laparoscopic resected gall bladder with thickened walls and concrement.

Hydrops of the gallbladder with beginning cholecystitis

By PedRad


History: 14 year-old girl with trisomy 21. Known cholecystolithiasis for two years, but shows no symptoms. Acute stomach aches with vomiting for three days. The patient currently shows right-sided upper quadrant pain. No fever, slightly elevated BSR, ASAT and gGT.


Findings:

Ultrasound 1:  Widened gall bladder without emptying, thickening of the gall bladder wall with increased echogenicity.  Depiction of a concrement giving an acoustic shadow at the transition to the cystic duct. :: Ultrasound 1 ::
Widened gall bladder without emptying, thickening of the gall bladder wall with increased echogenicity. Depiction of a concrement giving an acoustic shadow at the transition to the cystic duct.









OP 1:  Laparoscopic resected gall bladder with thickened walls and concrement. :: OP 1 ::
Laparoscopic resected gall bladder with thickened walls and concrement.









Discussion:

The preoperative sonogram allows the exact assessment of the position of the stone. The gall bladder wall thickness and the extent of filling of the gall bladder is also assessible. The intraoperative aspiration and drainage of the gall bladder should be considered, particularly with missing drainage after adequate stimulation.
After pain management, laparoscopic choecystectomy. Intraoperative confirmation of the hydroptic, filled gall bladder. The concrement was in front of the ductus cysticus.
After aspiration of the gall bladder and reduction of pressure, no problems with the laparoscopic removal of the gall bladder.

Article by: D. Schaper, V. Hofmann (Halle/S), www.PedRad.info (www.pedrad.info)



Differential diagnosis: Cholecystolithiasis

Diagnosis confirmation: Surgery / Histo



Category: Pediatric

Region / Organ: Abdomen-Other and unknown

Etiology: physical

References:
Daradkeh, S.S.,Suwan,Z., Abu-Khalaf, M.
Preoperative ultrasonography and prediction of technical difficulties during laparoscopic cholecystectomy.
World J Surg 1998 Jan;22(1):75-7

DE Caluwe, D., Akl, U., Corbally M.
Cholecystectomy versus cholecystolithotomy for cholelithiasis in childhood: long-term outcome
J Pediatr Surg 2001 Oct;36(19):1518-21




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