A Case Report of Intramural Gallbladder Abscess after Two Years

Tetsuya Kanehiro¹⁾, Hiroyuki Nobuhara²⁾, Takeshi Sudo³⁾, Yoshio Yuasa²⁾, Arata Kamimatsuse³⁾, Hiroaki Tsumura¹⁾, Yoshiaki Murakami³⁾ and Taijiro Sueda³⁾

Department of Surgery, Hiroshima Municipal Hunairi Hospital¹⁾
Department of Surgery, Itsukaichi Memorial Hospital²⁾
Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima university³⁾

We present a rare case of intramural gallbladder abscess which was resected two years later. A 92-year-old man seen for right upper abdominal pain was diagnosed as having acute cholecystitis and treated conservatively in November 2000. In November 2002, he again experienced right upper abdominal pain and was admitted for exacerbated cholecystitis. WBC was 9,050/mm³ and CRP 9.06 mg/dl, suggesting inflammation. Abdominal ultrasound showed localized liquid retention around the gallbladder and a septum-like structure. Abdominal computed tomography showed an enlarged structure resembling the gallbladder and an internal layered structure. Percutaneous abscess drainage identified an abscess cavity connected to the gallbladder, and necessitating surgery based on a preoperative diagnosis of acalculous cholecystitis and abscess around the gallbladder. Postoperative pathological findings showed gangrenous cholecystitis and intramural gallbladder abscess. Long-term follow-up of intramural gallbladder abscess developing from acalculous cholecystitis is rare. Such cases warrant early resection.

Key words
pericholecystic abscess, acute acalculous cholecystitis

Reprint requests
Tetsuya Kanehiro Hiroshima Municipal Funairi Hospital
14-11 Funairisaiwai-cho, Naka-ku, Hiroshima, 730-0844 JAPAN

Accepted
September 22, 2004

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