Abdominal adhesion causing obstruction and necrosis of the gallbladder’s fundus

A 90-year-old woman with no history of interest and no previous abdominal surgery attended the emergency department for abdominal pain and fever of 48 h' duration. Physical examination: pain in the right hypochondrium and positive Murphy’s sign. Laboratory tests showed signs of infection. Abdominal ultrasound: gallbladder with hourglass appearance, area of stenosis between the fundus and the rest of the gallbladder, findings compatible with acute cholecystitis at the level of the gallbladder fundus (Fig. 1). During laparoscopic cholecystectomy (Fig. 2a), an abdominal adhesion was found surrounding the gallbladder fundus, which was obstructed and necrotic; the proximal gallbladder had normal characteristics. Cholecystectomy was completed and a specimen was sent for pathological anatomy (Fig. 2b). The patient was discharged on the second postoperative day.

Fig. 1

Fig. 2

Diagnosis: Necrosis of gallbladder fundus caused by abdominal adhesion