A 75 yr old with a history of recently being diagnosed with gastric carcinoma, treated with a partial gastrectomy, presented with vomiting and fevers.
She had no other significant background medical history, however a recent PET scan had shown metastatic disease to her para-aortic lymph nodes.
On arrival to ED she was slightly jaundiced and was febrile at 38.5, other haemodynamics were normal.
She was very tender in the RUQ with a positive murphy’s sign.
ED ultrasound showed a very unusual looking GB, with thickened wall and hyperechoic material within the gallbladder.
I was unable to visualise the CBD (see image below).
She was treated for biliary sepsis and a CT scan was arranged.
The CT scan showed a likely ruptured GB , that had ruptured into the liver causing a liver abscess.
This was percutaneously drained in radiology, and she was admitted under the surgical team for further management.
After an approximate 3 week admission, she has been discharged for ongoing IV antibiotics
Dr Steve Korbel MBBS, BSc(med), FACEM, CCPU
St George Hospital, Sydney, NSW
Blogs are written by our EMUGs Team from across Australasia.