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Special Feature
June 2002

Image of the Month

Author Affiliations

GRACE S.ROZYCKIMDFrom the Department of Surgery, Emory University School of Medicine, Atlanta, Ga.

Arch Surg. 2002;137(6):741-742. doi:

A 28-YEAR-OLD WOMAN, gravida 4, para 3, aborta 0 (35 weeks), presented with a 36-hour history of acute onset of postprandial right upper quadrant pain, nausea, and vomiting. She described similar episodes of this pain during the preceding month. Her physical examination was remarkable for right upper quadrant tenderness, but her temperature was 36.2°C and her white blood cell count was 7.1 × 103/µL. Ultrasonography of her right upper quadrant showed a distended gallbladder with multiple stones, but results of liver function tests were normal.

The patient was treated conservatively for the presumed diagnosis of acute cholecystitis but became more symptomatic the next day. Initially, a laparoscopic approach was attempted, but because of perihepatic adhesions and the inability to visualize the gallbladder, the abdomen was opened and the findings in Figure 1 and Figure 2 were noted.

What Is the Diagnosis?

A.Acute cholecystitis

B.Gallbladder volvulus

C.Acalculus cholecystitis

D.Hydrops of the gallbladder