Case 47: Right upper quadrant pain
A 62 year old man with known gallstones presents with 3 weeks of progressive right upper quadrant pain. The pain has been constant but he has not had a fever.
1. What does the CT show?
An ill defined and heterogenous mass is present in the fundus of the gallbladder. There is evidence of calcification however this is suspicious for carcinoma of the gallbladder. There is no liver invasion or metastases. Likewise there is no ascites.
2. How would you manage this condition if you discovered it at the time of laparoscopic cholecystectomy?
Gallbladder carcinoma is rarely discovered pre-operatively at a resectable stage. If during laparoscopic cholecystectomy the gallbladder appears suspicious for carcinoma the laparoscopic approach should be abandoned. There are two options. The first is to abandon surgery to allow staging and referral to an appropriate specialist centre for management.
The second option is to convert to open surgery and proceed to definitive resection. This would involve en bloc resecction of the gallbladder and the adjacent liver and dissection of nodal tissue at the porta hepatis.