Differential Diagnosis

• Single most likely diagnosis
  • Post-operative haematoma infection or abscess: The patient's history of large post-operative bleeding, followed by a laparoscopic washout and haemostasis, and now presenting with erythema around the port site, a significant rise in CRP, and a dense fluid collection on CT scan, suggests an infected haematoma. The absence of a high fever and normal WCC does not rule out this diagnosis, as some patients may not exhibit typical signs of infection.
• Other Likely diagnoses
  • Bile leak: The rise in bilirubin, ALP, and ALT could indicate a bile leak, which is a known complication of laparoscopic cholecystectomy. However, the presence of a large fluid collection on CT scan, which is more suggestive of a haematoma, makes this diagnosis less likely.
  • Wound infection: The erythema around the port site could be indicative of a wound infection. However, the lack of other signs of infection, such as purulent discharge or a high fever, makes this diagnosis less likely.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Septic shock or severe sepsis: Although the patient does not currently exhibit signs of septic shock, such as hypotension or organ dysfunction, the rise in CRP and erythema around the port site could be indicative of an underlying infection that could progress to sepsis if not promptly addressed.
  • Biliary peritonitis: A bile leak could lead to biliary peritonitis, which is a life-threatening condition. Although the patient's symptoms do not currently suggest biliary peritonitis, it is essential to consider this diagnosis and monitor the patient closely.
• Rare diagnoses
  • Retained foreign body: Although rare, it is possible that a foreign body, such as a surgical sponge, was retained during the laparoscopic procedure, which could be causing the patient's symptoms.
  • Vascular injury: A vascular injury, such as a pseudoaneurysm, could be causing the haematoma. However, this diagnosis is less likely given the patient's presentation and the fact that the haematoma is not expanding rapidly.