SHM Converge Scientific Abstract ePoster Gallery-"Didn't You Take That Out?" a Case of Reformed Gallbladder After Subtotal Cholecystectomy

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This case describes a 52-year-old man with chronic alcohol-induced pancreatitis and biliary strictures who was hospitalized for severe abdominal pain. He underwent ERCP with stent exchange and developed post-ERCP pancreatitis. When his symptoms worsened, MRCP was obtained and unexpectedly showed acute cholecystitis, along with elevated inflammatory markers. He was started on IV antibiotics and surgery was consulted.<br /><br />He ultimately underwent a subtotal cholecystectomy for gangrenous cholecystitis, with drain placement. After initial improvement, the drain was removed on postoperative day 3 and antibiotics were de-escalated. However, he soon developed worsening severe abdominal pain. Repeat CT showed a distended, inflamed gallbladder remnant. Antibiotics were restarted, and he required interventional radiology percutaneous cholecystostomy for source control. After treatment, he improved and was discharged on oral antibiotics, with follow-up CT confirming reduction in remnant distention.<br /><br />The case highlights “reformed gallbladder,” a rare complication after subtotal cholecystectomy in which a gallbladder remnant can become a closed, infected space and mimic recurrent cholecystitis. Although this is usually a delayed complication, it can occur within days after surgery, as in this patient. Diagnosis is challenging because symptoms are often nonspecific and CT may be inconclusive; MRCP can be especially helpful. The key clinical message is to consider symptomatic gallbladder remnant in any patient with persistent or worsening abdominal pain after subtotal cholecystectomy, regardless of how soon after surgery it occurs. Early recognition and prompt source control are essential.

Asset Subtitle

Omer Hamad

Meta Tag

Author List Claire Collins, Hirotaka Kato, Kidus Shiferawe, Omer Hamad, Savannah Ray

Category Clinical Vignettes

Concept Subtotal Cholecystectomy

Concept Gallbladder Remnant

Concept Symptomatic Gallbladder Remnant

Concept Reformed Gallbladder

Concept Magnetic Resonance Cholangiopancreatography

Distinguished Non-Finalist

Presenter Organization University of Kentucky College of Medicine

Presenting Author Omer Hamad

Track Adult

Keywords

subtotal cholecystectomy

reformed gallbladder

gangrenous cholecystitis

post-ERCP pancreatitis

biliary stricture

MRCP

percutaneous cholecystostomy

gallbladder remnant

abdominal pain

source control

Subtotal Cholecystectomy

Gallbladder Remnant

Symptomatic Gallbladder Remnant

Reformed Gallbladder

Magnetic Resonance Cholangiopancreatography