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