Acute cholecystitis with colonic pseudo-obstruction
Known T3N0M1 sigmoid adenocarcinoma. Presented with 10 days of diarrhea, lethargy, decreased oral intake, nausea with vomiting, sensation of increasing abdominal pressure. No associated fevers.
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Distended large bowel to the level of a previous sigmoid anastomosis. Small bowel of normal caliber.
Multiple lesions of low density throughout splenic and hepatic parenchyma consistent with metastatic disease.
Diffuse gall bladder wall thickening with pericholecystic and perihepatic free fluid, consistent with expected imaging features of acute cholecystitis.
Clinical correlation of imaging findings suggested that the patient was suffering from colonic pseudo-obstruction which self-resolved. Interestingly, the imaging findings of acute cholecystitis were completely unexpected given that the patient had relatively unchanged liver function tests and the patient did not display clinical examination findings consistent with acute cholecystitis. The patient underwent laparoscopic cholecystectomy.