2025 Volume 45 Issue 3 Pages 417-421
A 93-year-old woman presented to the emergency department of our hospital because of the sudden onset of right hypochondriac pain. A contrast-enhanced CT scan revealed an enlarged gallbladder and prominent thickening of the gallbladder wall, but no biliary stones. A diagnosis of acute cholecystitis was made, and emergency laparoscopic cholecystectomy was performed. Intraoperative exploration revealed a small amount of biliary ascites, but no clear perforation of the gallbladder wall. The patient made good progress postoperatively, and she was discharged to home on postoperative Day 8. Because the pathology examination confirmed the absence of gallbladder perforation, the final diagnosis was transudative biliary peritonitis (TBP). The pathophysiology of TPB is unknown, and it is difficult to diagnose preoperatively. The key findings of CT and MRI in TBP are: (1) absence of an impacted biliary stone, (2) severe edema of the gallbladder wall, (3) gallbladder collapse, and (4) focal effusion around the gallbladder. These appear to be the characteristic findings of TBP, and emergency surgery should be performed when these findings are present.
