Traumatic injuries to the gallbladder are rare. This is attributed to its anatomical location and protection by the liver. Direct penetrating trauma is the commonest mechanism of injury. Here is the report of a 27-year-old otherwise healthy male who sustained gallbladder perforation following the penetration of abdominal injury in a domestic fight. A high index of suspicion is necessary for early diagnosis. He safely underwent an open cholecystectomy and his postoperative recovery was uneventful.

Neuroendocrine tumors (NET) arise from neuroendocrine cells and are an exceedingly rare malignancy in the gallbladder. In this case report, a 52-year-old woman with complaints of episodic abdominal pain for two months prior was admitted to our hospital. She had no other signs and symptoms and her laboratory tests were within normal limits. Ultrasonography showed a broad-necked mass (26×12 mm) in the gallbladder for which she underwent laparoscopic cholecystectomy. The final pathological diagnosis was a high grade neuroendocrine carcinoma of the gallbladder with involvement of the lymph nodes and omentum. The patient received the chemotherapy regimens of gemcitabine plus cisplatin, followed by docetaxel plus sunitinib for her metastatic liver lesions. She also underwent radiofrequency ablation. Serial CT-scans revealed metastatic liver lesions that had decreased in size, with no significant improvement. The patient refused additional treatment and at 46 months, she was doing well with no complaints of any pain, disease recurrence, or metastatic progression.

Volvulus of the gallbladder or gallbladder torsion (GT), is a condition in which an organ twists along its long axis leading to the vascular source compromise. The GT was first diagnosed in 1898 as a rare cause of idiopathic cholecystitis. Some 500 cases have been reported ever since, and they account for 0. 1% in acute cholecystitis cases. An 85-year-old male patient presented with epigastric abdominal pain that was referred to as the upper abdominal quadrant (UAQ). The pain did not radiate elsewhere but was constant and severe. Moreover, it did not change with eating; nonetheless, the patient had anorexia, nausea, and biliary vomiting that occur two times. Fever and chills, weight loss, and icterus were not observed. According to the ultrasound report, flat cholecystitiswas diagnosed, and the patient underwent cholecystectomy. During the operation, GT was confirmed. Diagnosis of GT in elderly patients without symptoms of acute abdomen and cholecystitis should be considered in differential diagnosis to prevent complications and mortality.

Fundal gallbladder abnormalities result from broad spectrum of pathologic that most of them have no pathological significance and normally causes no symptoms. Conversely, early incidental detection of malignant lesions is important because symptomatic lesions are often incurable. So use proper imaging to differentiate between them is important. Although ultrasound has been the choice screen method of gallbladder diseases, making an accurate diagnosis may be impossible. Now day, multiphase MRI and CT scan have become the imaging technique that are widely used to detect and to characterized gallbladder abnormalities. In crosssectional imaging analysis of finding included evaluation of thickness, contour, intralesional cystic areas, enhancement pattern, presence of stone, etc. may help to differentiated fundal gallbladder abnormalities. The porpoise of this educational exhibit is to describe gross anatomy and pathologic appearance of each abnormalities and demonstrate features of them in ultrasound, CT scan and MRI with emphasis on the specific characteristics and will review the role of imaging in the differentiation of these. Abnormalities included: Phrygian cap: Mostcommoncongenital anatomic variant of gallbladder that is asymptomatic and characterized by folding of the fundus on the body. Although ultrasound isn’ t always conclusive but usually clearly identify in CT scan and MRI. Fundal septation: It is rare and usually asymptomatic and result of incomplete cavitation of gallbladder bud. In ultrasound demonstrated as an echogenic band crossing the lumen and in CT scan and MRI usually clearly identify. Localized chronic cholecystitis: Most common form of clinically symptomatic gallbladder diseases that there is evidence of chronic inflammation in pathology and may have a history of biliary colic. Ultrasound demonstrate gallbladder wall thickening and usually with cholelithiasis, without any pericholecystic inflammation. In CT scan, focal fundal thickening with flat contour and adjacent gallbladder thickening is seen. The most common finding in MRI is cholelithiasis and wall thickening without any pericholecystic inflammation. Adenomyomatosis: Has been reported in 2-8% of cholecystectomy specimens and have a predilection for the middle and elderly aged womenand is usually asymptomatic or paucisymptomatic. It is widely accepted to be a degenerative disease and is characterized by Rokitansky-Aschoff sinuses that are responsible for the imaging finding. Specific ultrasound signs are anechoic intramural diverticulumwith or without comet tail artifacts. Optimal CT scan evaluation of gallbladder require IV contrast and Rosary sign is highly suggestive. MRI finding are focal mass, mural thickening and pearl necklace sign. Fundal gallbladder cancer: uncommon but most common primary biliary carcinoma and predominantly affects elderly women that often present when extend to liver or adjacent structures. Over 90% are adenocarcinoma. Cross-sectional appearance is that of a mass replacing the gallbladder (40%-65%), focal wall thickening (20%-30%) or an intraluminal polypoid mass (15%-25%). Ultrasound isn’ t usually useful if there isn’ t any invasion but there are several features that may be useful, polipoid lesions greater than 1 cm, focal wall thickening > 1 cm, heterogeneous mass or asymmetric thickening. CT scan with contrast is extremely helpful (dual phase) and finding suggesting cancer are hypo or iso attenuating heterogeneous mass, adjacent invasion, pronounced wall thickening(> 1 cm), thickness with mural irregularity or marked asymmetry. Caner in MRI is typically T1 hypo intense and T2 hyper compare with liver parenchyma, typically shows early irregular contrast enhancement which persists into delayed images. Stones are common. Conclusions: All of gallbladder fundal abnormalities should be kept in the mind during imaging and knowledge of the characteristic imaging finding of each abnormalities are essential in order to manage patients.

Gallbladder duplication is a rare congenital anomaly, which is not accompanied by specific symptoms,however, it is usually associated with cholelithiasis. A 52-year-old man is described, who was referred to the hospital complaining of pain. Ultrasonography indicated the presence of Boyden’, s Type II gallbladder duplication with stones in the left gallbladder and cholecystitis in both gallbladders. The patient underwent cholecystectomy. In the pathology report, chronic inflammation of the gallbladder was reported. Furthermore, the presence of a second gallbladder was confirmed.

Introduction & Background: Most of neoplasms arising from gallbladder and biliary tracts are malignant and unfortunately they are not uncommon. Gallbladder cancer is the fifth common gasterointestinal cancer whereas biliary tract carcinomas are less common. Patients usually present with nonspecific signs and symptoms of RUQ pain and weight loss; so most of them are treated as acute or chronic cholecystitis. Ultrasonography is one of the diagnostic tools that help us in this regard. Finding gallbladder wall thickening, is frequently a diagnostic sign of cholecystitis; however, it may also be the sign of cancer. Conclusively, it is crucial to be familar with imaging characteristics of malignancies and use them as a guide to diagnosis and treatment. 

BACKGROUND: The morbidity of unsuspected gallbladder carcinoma (UGC) has increased. This study was aimed to explore the factors which may influence the therapeutic strategies and prognosis of UCG. Additionally, long-term prognosis of laparoscopic and open surgeries of UGC was comparatively investigated.METHODS: Thirty-eight cases of UGC were enrolled in this study. Statistical analysis of survival was performed using the Kaplan–Meier test and the results were examined using the log-rank test.RESULTS: The morbidity of UGC was 0.43%. The cancer stagings were: pT1a (one), pT1b (11), pT2 (14), pT3 (10), pT3N1 (one), and pT4 (one). The median lifespan of the entire cohort was 20.0±6.5 months, one-year survival rate was 44%, and five-year survival rate was 11 %. One-year recurrence- free survival rate was 44% and three-year recurrence- free survival rate was 0 %. Twenty-eight patients sustained cancer recurrence and three patients sustained port-site cancer recurrence. The cancer staging (P<0.01) and radical resection (P<0.01) were independent factors for both overall and recurrence-free survival. Radical resection improved the prognosis of the patients with pT2 stage UGC (P<0.05), but no significant impact on the prognosis of the patients with pT1b (P=0.362) or pT3 stage (P=0.221) UGC. Survival rates were not significantly affected by the first operation no matter it was laparoscopic surgery or open surgery (P=0.12).CONCLUSION: Radical resection surgery is recommended in pT2 stage UGC. There is no difference for the long-term prognosis between laparoscopic surgery (cholecystectomy) and open surgery of UCG.

Fenestrated endovascular aortic repair of aneurysms with challenging necks has advanced significantly over the last three decades. In cases with extremely hostile proximal necks, such as the one described here (a common trunk between the superior mesenteric artery and the celiac artery), it may be necessary to cover the celiac trunk to ensure better graft attachment and avoid endoleaks. However, unexpected events can still occur, even with collateral circulation present. To our knowledge, this is the second reported case of gallbladder necrosis following fenestrated endovascular aortic repair.