Abstract
An 81-year-old man underwent uneventful radical cystoprostatectomy and ileal conduit urinary diversion for muscle invasive transitional cell carcinoma of the bladder. Postoperative course was complicated by prolonged ileus, which required nasogastric suction and total parenteral nutrition. On postoperative day 13 the patient had a low grade fever, and epigastric tenderness was noted on physical examination. Computerized tomography of the abdomen revealed a markedly enlarged gallbladder with inflammatory changes consistent with cholecystitis (see figure). After a general surgical consultation, cholecystectomy was scheduled for the following morning. Appropriate intravenous antibiotics were started. Later that evening abdominal pain worsened dramatically. Examination was consistent with frank peritonitis. Emergency exploratory laparotomy revealed a ruptured gallbladder with bilious intraperitoneal spillage. The patient underwent cholecystectomy and peritoneal lavage. He was in the intensive care unit 3 days before recovery. Pathological examination of the specimen revealed small calculi and acute cholecystitis.
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