Clinical History

An obese 40 year old woman presented with acute upper abdominal pain of sudden onset. On examination, she had a positive Murphy's sign. This specimen was removed at operation. histology revealed infiltration of the wall by neutrophil polymorphs. This is an example of cholelithiasis with obstruction of the cystic duct, and associated acute cholecystitis.


The gall bladder is markedly dilated and the wall is congested and attenuated. There is patchy haemorrhage in the wall especially in the fundus and neck (see back of specimen). A cholesterol calculus 10 x 15 mm in diameter is firmly impacted in the neck, obstructing the cystic duct. Although there is no obvious inflammatory exudate seen macroscopically,