We present a case study of a 56-y-old man who was admitted with acute abdominal pain and was found to have retroperitoneal hematoma from a ruptured duodenal aneurysm. Tc-diisopropyliminodiacetic acid cholescintigraphy showed incidental absent transit of radiotracer into the distal duodenum and severe enterogastric reflux, thought to be secondary to duodenal obstruction from the hematoma. Findings were confirmed on esophagogastroduodenoscopy, and the patient improved after subsequent gastrojejunostomy.

We present a case of a 79-year-old immunocompromised female admitted for abdominal pain and sepsis, who had an abdominal computed tomography (CT) showing distal gallbladder fundus wall thickening, pericholecystic edema, and a right posteroinferior hepatic abscess. Subsequent hepatobiliary scintigraphy with Tc-99m diisopropyliminodiacetic acid showed gallbladder filling of the proximal gallbladder fundus, yet no radiotracer filling of the distal gallbladder fundus. Further correlation with the initial CT showed a partial gallbladder stricture and a resultant altered morphology resembling a dumbbell-shaped gallbladder. Percutaneous cholangiogram also confirmed this dumbbell morphology. Nonfilling of radiotracer into the distal end of the dumbbell gallbladder correlating with CT findings of focal gallbladder inflammation indicated that there was a focal inflammation suggesting a distal dumbbell gallbladder cholecystitis. This case demonstrates a unique finding of focal inflammatory pathology involving an anatomic variant - the dumbbell-shaped gallbladder, and the challenges this anatomic variant presents in hepatobiliary scintigraphy image interpretation.