Case Presentation :
Case History/ Examination: A 70-year-old female, referred to our institution from a district hospital, presented with a month-long history of nausea and vomiting immediately following ingestion of oral liquids and semi-solids. Absent were complaints of abdominal pain or fever. Known for schizophrenia under regular treatment for five years and with a past medical history of treated filariasis in the left lower limb four decades ago (Figure 1), she had no record of diabetes mellitus, tuberculosis, or asthma, and no prior abdominal surgeries. A physical examination revealed a soft, non-tender, non-distended abdomen with a palpable, firm lump spanning from the right hypochondrium to the right iliac fossa (RIF) (Figure 2).
Methods: Imaging studies, including ultrasound and contrast-enhanced computer tomography (CECT) of the abdomen, indicated a significant, lobulated, multiloculated cystic lesion measuring (19 x 5.8 x 3) cm and approximately 120 ml in volume (Figure 3 and 4).
This lesion was observed abutting the inferior and medial surfaces of the liver, extending to the RIF region, with minimal fat stranding on its anteromedial aspect, leading to a provisional diagnosis of a large GB mucocele (Figure 3 and 4). Laboratory investigations were largely unremarkable, with a total leukocyte count (TLC) of 15,000 cells/mm3 and hemoglobin (Hb) levels at 10.9 g/dl. Initially scheduled for USG-guided percutaneous pigtail drainage (cholecystostomy), deteriorating hemodynamics necessitated an emergency laparotomy under general anesthesia. Intraoperatively, a GB perforation approximately 11 cm in size was discovered on the right lateral wall of the fundus, accompanied by an organized intraperitoneal collection tracking inferiorly from the GB along the right-sided greater omentum up to the RIF region (Figure 5 and 6). Surgical intervention included peritoneal lavage (Figure 7) with adhesiolysis and a left-sided abdominal drain placement.
Conclusion and Result: Subsequently, the patient was transferred to the ICU in an intubated state and remained on ventilatory support until succumbing on post-operative day 3 (POD 3).