Siphon-Like Gall Bladder Hydrops in Chronic Cholelithiasis
An 87-year-old woman came to our emergency room complaining of diffuse abdominal pain. Laboratory testing revealed microcytic anemia (hemoglobin 5.9 mmol/L) with normal leukocyte and platelet counts, as well as a high C-reactive protein concentration (48.4 mg/L) and elevation of the cholestasis parameters alkaline phosphatase (12.32 µmol/L/s) and gamma-glutamyltransferase (33.03 µmol/L/s), with normal bilirubin and transaminase values. Abdominal ultrasonography revealed intra- and extrahepatic cholestasis with a markedly enlarged gall bladder containing large concretions. Computed tomography then yielded the finding illustrated at left, a siphon-like, hydropic, stone-filled gall bladder extending into the pelvis, with a tortuous and enlarged cystic duct and a prepapillary concretion in the common hepatic duct (arrow). The latter was then removed via endoscopic retrograde cholangiopancreatography. Histological examination of the prominent papilla revealed a florid, longstanding erosive papillitis, most likely due to recurrent outflow of concretions. After removal of the concretion and insertion of a stent, the biliary pathways were promptly unblocked and the cholestasis parameters reverted to normal. Elective cholecystectomy was recommended.
Prof. Dr. med. Roland Reinehr, Dr. med. Anita Matthies, Abteilung für Innere Medizin, Elbe-Elster Klinikum Herzberg, firstname.lastname@example.org
Tabea Krönert, Abteilung für Radiologie, Elbe-Elster Klinikum Herzberg
Conflict of interest statement: The authors state that they have no conflict of interest.
Translated from the original German by Ethan Taub, M.D.
Cite this as: Reinehr R, Matthies A, Krönert T: Siphon-like gall bladder hydrops in chronic cholelithiasis. Dtsch Arztebl Int 2019; 116: 221. DOI: 10.3238/arztebl.2019.0221b