A 77-year-old woman with no history of disease was seen in the emergency room for 48-hour abdominal pain in the right hypochondrium, associated with conjunctival subictery.
Blood analysis: elevated bilirubin and C-reactive protein.
Computed tomography: hydrops vesicular, dilatation of the left intrahepatic bile duct, 8 mm bile duct with no content and left hepatic lobe.
She was admitted with a diagnosis of mild acute cholangitis, starting antibiotic therapy.
Magnetic resonance cholangiopancreatography MRCP - stenosis, stenosis of the distal bile duct, dilation of the intra-extrahepatic bile ducts of the right hepatic lobes and diffuse segmental cystic dilatation of the biliary tract
Suddenly, his general condition worsens with associated diffuse peritonitis, so urgent surgery is decided.
Right subcostal laparotomy was performed.
Apparently, there is a gallbladder with normal appearance; the left hepatic lobe is replaced by a fibrous-cystic complex with biliary leakage due to perforation at this level.
Intraoperative cholangiography confirmed cholelithiasis and contrast leak in the lateral segments of the left hepatic lobe.
Treatment: cholecystectomy, resection of the atrophic hepatic segment, cystotomy with extraction of calculus, recurrence of Kehrs disease.
Correct postoperative evolution.
Anatomopathological study: multicystic biliary hamartoma of 1.3 cm maximum axis with associated acute inflammatory component, mainly affecting the surface.
