Ultrasound Pictures Perforated Gallbladder

Clinical manifestations Perforated Gallbladder
Severe pain followed abruptly by a more or less pain-free interval, followed in turn by a recurrence of pain and rigidity. The patient becomes seriously ill when peritonitis supervenes.
Diagnosis Perforated Gallbladder
x History: Lithiasis, inflammation, course of illness
x Sonography
x Radiography: Plain abdominal radiograph


Gallstone perforation. A gallstone (ST) with a bright surface echo
and acoustic shadow (S) has perforated into the duodenal bulb (DB).
S = stomach

Perforated gallbladder The gallbladder (GB) has ill-defined margins with a nonhomogeneous internal echo pattern and a fistulous tract (F) leading into the duodenum (D). L = liver

Ultrasound Pictures Perforated gallbladder. a The gallbladder has a thickened wall and is
still fluid-filled because the perforation is confined. The wall discontinuity is caused
by detached mucosa.

Perforated gallbladder (same woman, 65 years of age). Scan shows a hypoechoic mass with ill-defined margins around the gallbladder due to suppurative pericholecystitis.
Sonographic findings Perforated Gallbladder:
x With cholecystitis:
– Gallbladder poorly demarcated from its surroundings
– Irregular, anechoic rim.
x Discontinuity in the gallbladder wall
x Thickening of the gallbladder wall
x Small amounts of free fluid in the abdomen, particularly around the liver.
Accuracy of sonographic diagnosis Perforated Gallbladder

: A perforated gallbladder may be indistinguishable from pericholecystitis by ultrasound. A discontinuity in the gallbladder wall suggests the correct diagnosis, which is confirmed by demonstrating a direct
communication of the gallbladder lumen with the peritoneal cavity.
sonographic  Perforated Gallbladder