Presentation
Sludge incidentally detected in the gall bladder of a thin-built young adult suffering from disseminated abdominal tuberculosis.
Patient Data
Sludge having homogenous echoes and forming an air-fluid level is seen in the posterior (dependent) portion of the gall bladder. Note the absence of any acoustic shadow. The sludge changes shape with changing patient position, occupying the dependent posterior portion of the gall bladder. Associated multiple lymph nodes and psoas abscess visible as evidence of disseminated tuberculosis.
Case Discussion
Pregnancy, low-fat diet, rapid weight loss in obese, and compromised liver function 1 are known causes of gall bladder sludge. In the present case, the patient suffered from disseminated abdominal tuberculosis and was incidentally found to have sludge in the gall bladder.
A possible pathophysiological mechanism could be the tubercular involvement of the ilio-cecal junction, which is involved in the absorption of bile in blood 2. When the enterohepatic circulation of bile is disturbed, levels of bile salts and phospholipids are decreased, creating a favorable environment for sludge formation in the gall bladder 3.
The case emphasizes the need to screen patients with disseminated tuberculosis for the sludge in the gall bladder.
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