Chronic Cholezystitis Misleading as Tumor of the Gall Bladder with Concomitant Liver Abscess

Abstract

We report on a 58 year-old male who presented with nausea, a painful tumor palpable in the upper right epigastrium, moderate fever without leukocytosis. Both ultrasonic scan and subsequent computerized tomography lead to the primary diagnosis of a malignant tumor of the gall bladder infiltrating the liver and inducing an intrahepatic abscess formation in segments 4b and 3. The patient was scheduled for emergency operation, i.e. abscess drainage, cholezystectomy, and hemihepatectomy. However, at operation a purulent chronic cholezystitis was found without involvement of the liver itself. Consequently, a cholezystectomy was necessary and performed. Histological examination of the gall bladder revealed no signs of malignancy. The patient had an uneventful recovery and was discharged on post-operative day seven. This case report shows the difficulties in the differential diagnosis of inflammable processes and malignancies, which affect the gall bladder and adhering structures. A chronic inflammable process can mimic solid tumors. Despite cost-effective diagnostic tools the correct diagnosis was finally found by surgery.

An atypical presentation of intrahepatic perforated cholecystitis: a modern indication to open cholecystectomy. Report of a case

“…Despite chronic processes with fistula formation, its clinical presentation, even in its rarity, is more often acute (nausea, vomiting, upper quadrant pain, fever, altered mental status, and septic shock) [12,13], or the consequence of an acute perforation [10]. The diagnosis is usually made by US or CT scan.…”

“…This subtle clinical picture can be misleading for the physician causing a delay in obtaining prompt imaging tests. Some reports have highlighted the difficult differential diagnosis between gallbladder cancer versus liver abscess [12,14,15]. Because of the very few reports to date, there is no consensus on the standard treatment of such a rare condition [15,16].…”