MRI of perforated gall bladder

Abstract

Gall bladder perforation is a dreaded complication of acute cholecystitis that, if not diagnosed early in the course, might have a poor prognosis. Both CT and ultrasonography have been used until now extensively for the diagnosis of acute cholecystitis, but diagnosis of perforation is always difficult. Magnetic resonance, by its superior soft tissue resolution and multiplanar capability, is a better modality and should fare better than ultrasonography and CT, as demonstrated in our case. Magnetic resonance imaging demonstrates the wall of the gall bladder and defects to a much better advantage and more convincingly. In addition, MR colangiopancreatography images demonstrate the biliary tree better than other modalities. We suggest that in the case of acute cholecystitis, if perforation is suspected and CT and ultrasonography are not conclusive, MR should be the modality of choice. It can be used as a first line of investigation; however, it might not be cost-effective.

Gallbladder Perforation- Presenting as an Acute Abdomen

“…1 Multimodality approach and identifying accurately the type of perforation will help in moving on to effective management of the case. 13,14,15,16 …”

An Unusual Presentation of Gall Bladder Perforation with Hepatic Subcapsular Collection

“…In the early decades of the last century, Niemeier categorized perforation into three types [12]: type 1 (acute 33-37 %), which manifests with generalized peritonitis; type 2 (subacute 43-53 %), which denotes localization of fluid at the site of perforation with the formation of a pericholecystic abscess; and type 3 (chronic 10 % to 19 %), in which internal (bilio-biliary or bilio-enteric) or external fistulae occur [1]. Recent studies cite a higher incidence of subacute perforation/type II perforations as compared to other types [2].…”

“…Ultrasound and CT in combination are used to diagnose suspected gallbladder perforation; recently MRI scan has also been suggested as more accurate than these two conventional imaging techniques [12]. Ultrasonography is usually the initial mode of investigation in cases of suspected gallbladder perforation.…”

Spontaneous Perforation of the Gall Bladder: A Case Report

“…Magnetic resonance imaging (MRI) may demonstrate the wall of the gallbladder and defects also. The biliary tree is better demonstrated by MRCP than other modalities in presence of gallbladder perforation in suspected cases of acute cholecystitis [14]. If USG and CT scans are not conclusive, the MRI is the modality of choice.…”