"Pseudogallbladder" appearance in partial afferent loop obstruction in a patient with cholecystectomy

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Abdominal Imaging

Background:

• Billroth II gastrectomy is a surgical procedure for peptic ulcers.
• Cholecystectomy is the surgical removal of the gallbladder.
• Post-surgical complications can arise years after abdominal procedures.

Observation:

• A patient presented with right upper quadrant (RUQ) abdominal pain 40 years after a Billroth II gastrectomy.
• The patient was also unaware of a prior cholecystectomy.
• Initial imaging suggested gallbladder enlargement and gallstones.

Findings:

• Gray-scale abdominal ultrasonography and technetium-99m iminodiacetic acid (Tc 99m-IDA) hepatobiliary imaging were performed.
• These imaging modalities were interpreted as showing an enlarged gallbladder with cholelithiasis (gallstones).
• The actual cause was an obstructed afferent loop of the Billroth II anastomosis, which mimicked gallbladder pathology on imaging.

Implications:

• This case highlights the importance of considering long-term surgical history in diagnosing abdominal pain.
• Imaging findings can be misleading in patients with complex surgical histories.
• Accurate interpretation requires correlating imaging with surgical anatomy and potential complications.