Biliary System
Last updated (28 October 2003)
Good Stuff
Spot Diagnosis
Biliary System
Padding space Perforated Gallbladder
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Perforated Gallbladder Click on the image to download a larger version
This image shows the appearce of the gallbladder on opening it up.
What do you see?
Single large gallstone in Hartman's pouch
Severe inflammation in Hartman's pouch
Macroscopic evidence of cholesterolosis of the gallbladder
Prominant Rokitansky Aschoff sinuses

The answer

The inside of the gallbladder is show. A single large gallstone is lying in the fundus. There is severe inflammation in the area of Hartman's pouch. Just above Hartman's pouch there is a hole in the gallbladder indicated by the tip of the scissors.

The student may say

I can see the inside of the gallbladder. To the right a single large gallstone is seen lying in the fundus. To the left there is evidence of severe inflammation in Hartman's pouch.

It is most likely that the stone seen on the right was impacted in Hartman's pouch, (as seen on ultrasound). The inflammation would support that. The perforation seen just above Hartman's pouch would correspond to a site in the gallbladder wall that was stretched and thereby liable to pressure necrosis.

Small print

The gall stone is seen in the fundus of the gallbladder.

There is no macroscopic evidence of cholesterolosis here. Cholesterolosis appears as multiple white spots on opening the gallbladder.

Rokitansky Aschoff sinuses are only seen on microscopy.

Adrian P. Ireland