Tan Savannah, Adams Zoe, Rudkin Scott, Matonis Danielle
University of California, Irvine Medical Center, Department of Emergency Medicine, Orange, CA.
University of California, Irvine, School of Medicine, Irvine, CA.
J Educ Teach Emerg Med. 2025 Apr 30;10(2):V14-V16. doi: 10.21980/J8DD26. eCollection 2025 Apr.
An 18-year-old female presented to the emergency department (ED) with two days of right lower quadrant pain and associated nausea and emesis. After relevant information was gathered and with physical exam findings of a tender right lower quadrant, positive psoas sign, positive Rovsing sign, and pain with right heel tap, the patient was presumed to have appendicitis. However, imaging contradicted the initial leading diagnosis and revealed a markedly distended, hydropic gallbladder with its tip near the umbilicus. Findings of the distended gallbladder with marked wall thickening and pericholecystic fat stranding and edema confirmed acute cholecystitis, and the patient was taken by general surgery for cholecystectomy. Together, this unusual presentation and this unexpected diagnosis shine light upon another facet of the hydropic gallbladder while also serving as a salient reminder to contemplate a broad differential regardless of seemingly classic presentations of illnesses.
Cholecystitis, hydropic gallbladder, abdominal pain, appendicitis.
一名18岁女性因右下腹痛两天并伴有恶心和呕吐前往急诊科就诊。在收集了相关信息并进行体格检查后，发现右下腹压痛、腰大肌征阳性、罗夫辛征阳性以及足跟叩击痛，该患者被推测患有阑尾炎。然而，影像学检查结果与最初的主要诊断相矛盾，显示胆囊明显扩张、积水，胆囊尖端靠近脐部。胆囊扩张伴明显壁增厚以及胆囊周围脂肪条索状改变和水肿的表现证实为急性胆囊炎，该患者接受了普通外科手术进行胆囊切除术。这种不寻常的表现和意外的诊断共同揭示了积水性胆囊的另一个方面，同时也显著提醒人们，无论疾病的表现看似多么典型，都要考虑广泛的鉴别诊断。
胆囊炎、积水性胆囊、腹痛、阑尾炎。
