40 year old presents with a right upper quadrant pain of 5 years duration. This was associated with painful crises during fat meals leading to vomiting, loose bulky offensive stools. He also complained of waxing and waning jaundice over the period. He does not recount episodes  of itching. He is not a known sickle cell disease patient. Had orchidopexy done 13 years ago for testicular torsion
Examination: healthy looking , afebrile, tinge of jaundice on conjunctiva.  RUQ tenderness on deep palpation ,Murphy’s sign negative, no reffered pain to right infrascapular region, gallbladder non palapable, rest of abdomen normal soft, spleen enlarged but non tender, liver non palpable
Diagnosis : Chronic cholycystitis
Investigation :
Abdominal  ultrasound :  revealed multiple  stones in the gallbladder. Gall bladder wall thickened. No intra or extrahepatic bile dilatation , spleen enlarged 17.1cm
FBC: normal finding in WBC
LFT    :  AST 53 U/L              ALT 119 U/L (    10-41 )           ALP 166.6  (35-129),                           GGT 319.(1 6-70                   ALB  46.80 ( 35-52)               TOTAL BIL  38.1 ( 1-17) ,                DIRECT BIL   12.72 (0-3.4)                                                  INDIRECT BIL   25.4         (1.5-14)
Preoperative diagnosis : Calculous cholecystitis
Surgery : Elective Open Cholecystectomy
Intraoperative details : Kochers incision used to perform open cholecystectomy, gallbladder sent to histopathology
Findings : Fibrotic gall bladder firmly attached to gall bladder fossa . Gall bladder latter opened to reveal multiple black pigmented stones . No gross evidence of malignancy obvious
Credits : Drs Joseph Yorke, Charles Appiah , Richard Ametih, Department of surgery KATH, Kumasi  02.09.13