Thursday, March 24, 2016

White Bile


A young woman presents with right upper quadrant abdominal pain. Ultrasound shows a stone in the cystic duct. You take her to the operating room for a cholecystectomy. You find a quite distended gallbladder, but what surprises you is that when you aspirate fluid from the gallbladder, it is colorless and mucoid.

Challenge: What's the diagnosis?

Image shown under Creative Commons Attribution Share-Alike License, from Wikipedia.

2 comments:

RaH said...

My thoughts are: reactive mucus production in a stone-caused cholecystitis, or a gallbladder mucocele, i tend for the second one.

Craig Chen said...

yes - i had never heard of this until a surgery resident friend of mine suggested it as a case of the day
-
White Bile

Gallbladder mucocele, also known as gallbladder hydrops, occurs if prolonged impaction of a stone leads to a distended gallbladder filled with colorless, mucoid fluid. In this case, there is absence of bile entry to the gallbladder and absorption of all the bilirubin within the gallbladder.

Source: UpToDate.