Pseudogallbladder Appearance on Ultrasonography After Cholecystectomy and Left Hemihepatectomy: A Postoperative Biliary Imaging Pitfall Clarified by MRCP

Abstract

Accurate identification of postoperative biliary anatomy following hepatobiliary surgery can be challenging because normal anatomical landmarks are altered. A 75-year-old woman who had undergone cholecystectomy and left hemihepatectomy four months earlier for intrahepatic bile duct stones presented with jaundice, generalized pruritus, epigastric pain, and cholestatic laboratory abnormalities, including elevated direct bilirubin levels. Ultrasonography demonstrated an elongated cystic structure in the gallbladder fossa containing echogenic intraluminal material suggestive of sludge and/or stones, mimicking the gallbladder on postoperative imaging.

MRCP showed that the cystic structure in the gallbladder fossa was continuous with the biliary tree, consistent with a dilated postoperative biliary segment. A few stones were present within this structure, and additional stones were identified in the intrahepatic bile ducts and distal common bile duct. The patient subsequently underwent endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy, stone extraction, and biliary stent placement. Follow-up laboratory and MRCP findings showed interval improvement, although residual stones persisted.

This case shows that ultrasonography may be misleading in patients with altered postoperative biliary anatomy. MRCP is valuable for demonstrating ductal continuity and for clarifying the true anatomical origin of a gallbladder-like postoperative biliary structure.