“Hole sign” of the gallbladder

Excerpt

The “hole sign” of gallbladder represents direct visualization of a perforation in the gallbladder [1]. Gallbladder perforation, a rare and dangerous complication of acute cholecystitis, occurs most commonly in the fundus, owing to poor blood supply. Gallbladder perforation may develop as early as 2 days as late as several weeks after the onset of the symptoms. Gallbladder perforation may occur in calculous as well as acalculous gallbladders. Identification by imaging is essential because of the high morbidity and mortality. Demonstration of flow between the lumen of the gallbladder and pericholecystic abscess across gallbladder wall defect on color Doppler and identification of calculi within the perihepatic collection are the two other signs described with gallbladder perforation [1]. Ultrasonography of this patient with acalculous cholecystitis showed the “hole sign” in the superior wall of the sludge filled gallbladder with a pericholecystic collection along the medial aspect of the gallbladder (Figs. 1 and 2). Ultrasonic signs, especially the “hole sign” helps in unequivocally establishing the diagnosis of gallbladder perforation [2]. This patient underwent emergency cholecystectomy and responded well to treatment.

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