2023 Volume 65 Issue 4 Pages 361-367
An 83-year-old female presented to our hospital with vomiting. Dilation of the bile duct and a partial deficit of the gallbladder wall were seen on contrast-enhanced CT. A gastric wall or intraperitoneal abscess was suspected as loculated fluid accumulation around the stomach was confirmed. A gastric wall abscess seemed unlikely as EUS suggested that the five-layered structure of the gastric wall was intact. MRI revealed elevated choledocholithiasis and multiple non-signal areas resembling biliary calculi, in the abscess cavity around the stomach. After choledocholith removal by ERCP on day 9, leakage of contrast agent into the abdominal cavity was confirmed on cholecystography through the cystic duct. We speculated that perforated cholecystitis might have caused the intraperitoneal abscess. Abscess drainage was performed by placement of an endoscopic transnasal drainage tube in the abscess cavity. After the procedure, the inflammatory reaction diminished immediately and the general condition of the patient improved. Radical surgery was performed on day 29, and a diagnosis of lesser sac abscess due to perforated cholecystitis was made. The patient was subsequently discharged with no postoperative complications.
