Chronic hepatic changes.
Collapsed gallbladder with inflammatory pattern at the neck of the gallbladder.
Undefined free fluid.
Reactive mesentery.
Age related renal changes.
Given that the free fluid is serosanguinous with neutrophilia recommend exploratory surgery with examination of the gallbladder and common bile duct. This is not an evident gallbladder mucocele; however, this is consistent with potential rupture of the gallbladder and secondary bile peritonitis or occult neoplasia that may be exacerbated by recent events. Multiple biopsies of any abnormal tissue, but specifically the liver would be recommended at the time of surgery. Given the patient’s presentation I do not feel that waiting on a surgical exploratory is likely an option and given that the inflammatory mesenteric pattern appears to be coalesced around the gallbladder, leakage of the gallbladder owing to collapse is a strong suspicion. Chronic cholecystitis with collapsed gallbladder often presents in this way especially given the chronic hepatic changes and would suggest a history of chronic inflammatory liver disease. Guarded prognosis. Coagulation panel +/- plasma transfusion may be necessary in this patient depending upon any clinical decline that may occur in the CBC chem profile in the next 24 hours.