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Abdominal wall abscess: more than meets the eye.
Jamish Gandhi1, Natasha Gandhi
1Hutt Hospital, General Surgery and Gynaecology, 1027 High Street, Avalon, Lower Hutt, 5011, New Zealand.
BMJ Case Reports
|February 9, 2012
Summary
A perforated gallbladder caused an abdominal wall mass in an elderly patient. Despite antibiotics and percutaneous cholecystostomy, the patient succumbed to the severe abdominal infection.
Area of Science:
- Gastroenterology
- Abdominal Imaging
- Infectious Disease
Background:
- Gallbladder perforation is a rare but serious complication of cholecystitis.
- Elderly patients with comorbidities are at higher risk for severe outcomes.
Purpose of the Study:
- To report a case of gallbladder perforation presenting as an abdominal wall mass in an elderly patient.
- To discuss the diagnostic challenges and management of such a rare presentation.
Main Methods:
- Case report of an 83-year-old male with a right-sided abdominal wall mass.
- Diagnostic workup included abdominal X-ray and computed tomography (CT) scan.
- Management involved antibiotics and CT-guided percutaneous cholecystostomy due to surgical non-candidacy.
Main Results:
- CT scan revealed a thick-walled gallbladder with calculi and air, consistent with perforation.
- Extensive air and fluid collection was noted in the abdominal wall layers.
- The patient's condition deteriorated despite medical and radiological interventions, leading to death.
Conclusions:
- Gallbladder perforation can present atypically as an abdominal wall mass.
- Prompt diagnosis and management are crucial, though outcomes can be poor in frail patients.
- Percutaneous cholecystostomy may be a temporizing measure in non-surgical candidates.
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