Clinical Presentation

A 79-year-old man who has pancreatic cancer presents with right upper quadrant pain 2 days after stent placement for malignant biliary obstruction.

(A) Coronal contrast-enhanced computed tomographic (CT) scan shows metallic and plastic biliary stent s in place (arrow). (B) Thickening (arrow) and rupture of the gallbladder wall, resulting in a communicating hepatic abscess (arrowhead). The absence of gallstones indicates acalculous cholecystitis (AC). (C) Axial contrast-enhanced CT scan shows sloughing of the gallbladder epithelium (arrows), indicating gangrenous cholecystitis.

Differential Diagnosis