Biliary System
Last updated (28 October 2003)
Good Stuff
Spot Diagnosis
Biliary System
Padding space No stone?
Padding space Q1
Padding space Q2
Padding space Q3
Padding space Q4
Padding space Q5
No stone? Click on the image to download a larger version
This lady complained of severe right upper quadrant pain. An ultrasound showed evidence of an inflammed gallbladder but no gall stones were seen. She is undergoing a surgical procedure. What is this procedure?
Upper gastrointetinal endoscopy
Snare excision of a colonic polyp
Laparosopic excision of a left ovarian cyst
A laparoscopic cholecystectomy

The answer

These images are taken at the time of a laparscopic cholecystectomy.

What the student may say

This looks like a laparscopic cholecystectomy.

We can see two instruments in position. The left hand one is holding onto Hartman's pouch, the right hand one is doing the dissection. The image on the left is early in the dissection and the peritoneum over the cystic duct has been opened. The image on the right shows thing further on in the operation and the instrument on the right is being carfully passed behind the cystic duct.

Small print

The is not an upper gastrointestinal endoscopy. The appearances are not in any way typical. In addition, the instruments seen in the image could not have been introduced through the endoscope.

This is not a colonoscopy. The appearance are not in any way typical. Once again the instruments seen in the image could not have been introduced through the colonoscope.

This is a laparosopic image but it does not show the ovary. The large purple structure behind the ovary is the liver so this is not the ovary it is the gallbladder.

Acalculous cholecystitis is not common. It mainly occurs in the setting of patients who are starved, for instance a patient on long term total parentral nutrition. Diabetics are more prone to it than non diabetics. One must also bear in mind that ultrasound examination is not 100% accurate. It may fail to detect gallstones.

Adrian P. Ireland