A CASE OF INTRAMURAL TYPE OF PERICHOLECYSTIC ABSCESS WHICH SHOWED AN INTERESTING SHAPE IN CT SCAN FINDINGS

Abstract

Pericholecystic abscess is formed by a leakage of infected bile juice from necrosed and/or perforated portion of the gallbladder mucosa due to cholecystitis. In this paper a case of pericholecystic abscess which showed an interesting CT findings of the gallbladder is reported. A 75-year-old male was admitted to the hospital because of a sudden onset of right upper abdominal pain after a lunch. Abdominal CT scan findings of the gallbladder performed preoperatively had a strange shape which seemed like a record disk. It was composed of a thin capsule, a large low attenuation area like a record disk, an enhanced small area like a ring and a small low density area like a axis. At the operation the serosal layer was extremely swelling and a large amount of pus was discharged by the incision. A simple cholecystectomy was performed. The serosal layer of the specimen was extremely swelling and thickening, and the abscess developed all over the subserosal area, whereas muscle layer and mucosal layer became atophic like a stick. A low attenuation area like a disk in CT findings exactly corresponded to the pericholecystic abscess developed in the subserosal layer. Pericholecystic abscesses are classified into three types, viz, gallbladder bed type, intramural type, and free peritoneal cavity type. Our case was diagnosed as typical intramural type of pericholecystic abscess.