Features suggestive of gallbladder hydrops ( gallbladder mucocele). The gallbladder remained moderately distended over multiple visits and multiple imaging studies. There is likely cystic duct obstruction due to sludge/ mucin accumulation with the calcified gallstones². There was ongoing biliary colic and epigastric pain over a period of 4 months. The patient underwent laparoscopic cholecystectomy due to poor response to conservative management and the onset of deteriorating inflammatory markers and liver function tests. Histology confirmed acute on chronic cholecystitis.

Intrinsic obstruction of the cystic duct (gallstone/ tumor/ polyps ) or extrinsic compression (tumor/ lymph nodes/ other ) represent the causes of gallbladder hydrops^2,3,4.

Kawasaki disease (a medium vessel vasculitis) with periportal inflammation spreads to involve the cystic duct and represents an unusual cause of gallbladder hydrops in infants and children mostly under 4 years of age ^3,4.

Case assistance: Dr K.Govender.