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Is a Gallbladder Coming Back? A Seroma in the Gallbladder Fossa

  • Ren Kuwabara
    Affiliations
    Departmenst of Internal Medicine, Nagano Chuo Hospital, Japan
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  • Yukinori Harada
    Correspondence
    Requests for reprints should be addressed to Yukinori Harada, Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, 321-0293 Japan.
    Affiliations
    Departmenst of Internal Medicine, Nagano Chuo Hospital, Japan

    Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan
    Search for articles by this author
Published:October 31, 2020DOI:https://doi.org/10.1016/j.amjmed.2020.09.040
      An 88-year-old man presented to the hospital with a 2-day history of fever and vomiting. He had developed emphysematous cholecystitis 14 days earlier (Figure A), which was treated with laparoscopic cholecystectomy on the same day, after which he was discharged without any complications 5 days later. On physical examination, his vital signs were stable, but he had a low-grade fever. Only abdominal distention without icterus or abdominal tenderness was observed. Laboratory examinations showed a slightly increased white blood cell count and an elevated alkaline phosphatase level. Contrast-enhanced abdominal computed tomography revealed a cyst with a thickened wall, which contained a highly dense material, in the gallbladder fossa (Figure B); it appeared to be similar to a gallbladder with gall stones. Abdominal ultrasonography also showed a gallbladder-like cystic lesion containing acoustic shadowing artifacts. The cyst was originally suspected to be an abscess. However, percutaneous transhepatic drainage revealed that the content of the cyst was gelatinous, which was inconsistent with an abscess. He was diagnosed with a seroma. His symptoms improved after drainage of the gastric contents. After the drainage, upper gastrointestinal endoscopy showed edema of the duodenal mucosa, which was considered the cause of his symptoms. He was discharged and did not develop any complications.
      Figure
      Figure(A) Contrast-enhanced abdominal computed tomography scan before laparoscopic cholecystectomy showing enlarged gallbladder with poorly enhanced wall and gas in the gallbladder, which is consistent with emphysematous cholecystitis. (B) Contrast-enhanced abdominal computed tomography scan 14 days after laparoscopic cholecystectomy showing a cystic structure with a thickened wall containing a highly dense material in the gallbladder fossa. It appears to be similar to a gallbladder with gall stones.
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