Asymptomatic gangrenous cholecystitis diagnosed using contrast-enhanced ultrasonography in a patient with pancreatic cancer

Abstract

A 72-year-old female without abdominal symptoms visited our hospital for routine follow-up while undergoing pancreatic cancer treatment (using TS-1). Her vital signs were normal, and her abdomen was soft and non-tender. Blood test revealed elevated C-reactive protein levels with normal white blood cell count. Computed tomography was performed for follow-up of pancreatic cancer. Contrast-enhanced computed tomography showed partial discontinuity and irregular thickness of the gallbladder wall; however, a definitive diagnosis was not obtained due to unclear imaging. Contrast-enhanced transabdominal ultrasonography revealed intraluminal membranes in the gallbladder and a perfusion defect at the bottom, indicating gangrenous cholecystitis. Surgical resection was performed, and pathological examination showed severe necrosis of the gallbladder wall, consistent with the findings of contrast-enhanced transabdominal ultrasonography.

Keywords: Asymptomatic diseases; Gallbladder; Gangrenous cholecystitis; Transabdominal ultrasonography.

Fig. 1

Findings of the contrast-enhanced computed tomography. Irregular thickness and partial discontinuity of the gallbladder wall with projection of fluid into the liver was observed. (A) Axial image. (B) Coronal image. (C) Sagittal image.

Fig. 2

Contrast-enhanced transabdominal ultrasonography revealed (A) intraluminal membranes and (B) perfusion defects at the bottom of the gallbladder.

Fig. 3

(A, B) Macroscopic findings of the removed gallbladder. Pathological findings showed infiltration of inflammatory cells and severe necrosis of the gallbladder wall. No malignant cells were found in the gallbladder. (C) Hematoxylin and eosin staining under × 40 magnification and (D) × 200 magnification.