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PATHOLOGY OF THE GALLBLADDER AND BILIARY TREE 49
CBD
LOWER END
A
B
Figure 3.12 (A) Anomalous insertion of the cystic duct (arrow) into the lower end of the CBD. (B) Appearances of
case in (A) are confirmed on ERCP. A stone is also present in the duct.
the cholecystoenteric fistula (Fig 3.11B). If the
condition is not promptly diagnosed, recurring
cholangitis leading to secondary biliary cirrhosis
may result.
On ultrasound the gallbladder may be either
enlarged or contracted and contain debris. A stone
impacted at the neck may be demonstrated together
with dilatation of the intrahepatic ducts with a
normal-calibre lower common duct (Fig. 3.14).
The diagnosis, however, is difficult, and ERCP is
generally the most successful modality. Although
rare, it is an important diagnosis as cholecystectomy
in these cases has a higher rate of operative and postoperative
complications. 7
RUQ
A
B
Figure 3.13 (A) Postoperative bile collection in the gallbladder bed. (B) Hyperechoic, irregular mass in the gallbladder
bed which represents a resolving haematoma after laparoscopic cholecystectomy.