Gallbladder empyema is a complication of acute cholecystitis characterized by extensive pus formation from invading bacteria and distension of the gallbladder, which may lead to life-threatening sepsis in the absence of early therapy. The clinical presentation is not significantly different from acute cholecystitis, comprising fever, chills, and right upper quadrant abdominal pain, as main symptoms. Imaging studies are used to support clinical suspicion.
The inflammation of the gallbladder (mostly due to the presence of a gallstone), known as acute cholecystitis, can further lead to the development of various complications, one of the most important being gallbladder empyema . It is seen in approximately 2-11% of patients who suffer from cholecystitis  and is caused by bacterial superinfection of the bile that is trapped in the gallbladder, leading to pus formation and distension of the gallbladder lumen (together with increased wall thickness)  . For this reason, the term suppurative cholecystitis is often used as a synonym in the medical literature  . Males have shown to be at an increased risk for the development of gallbladder empyema compared to women, whereas diabetes mellitus was also identified as a predisposing factor  . The clinical presentation is largely similar to acute cholecystitis - fever, chills, and pain in the right upper quadrant of the abdomen, which could be accompanied by severe weakness (prostration)  . Symptoms may rapidly develop, and in the setting of sepsis (predominantly caused by gram-negative pathogens) or perforation, the condition might be life-threatening  . For this reason, early recognition is necessary in order to facilitate proper therapy  .
Entire Body System
The clinical presentation is largely similar to acute cholecystitis - fever, chills, and pain in the right upper quadrant of the abdomen, which could be accompanied by severe weakness (prostration). [symptoma.com]
[…] or signs of infection • Fever or WBC with dilated GB concerning for empyema • Cholecystectomy for GB hydrops if patient is symptomatic • Urgent cholecystectomy for empyema (Left) Oblique ultrasound shows an enlarged gallbladder in a 5 year old with fever [clinicalgate.com]
As the disease progresses, severe pain and associated high fever, chills, and even rigors may be reported. Patients with diabetes or immunosuppression may exhibit few signs and symptoms. [emedicine.medscape.com]
However, if localized reely perforation has occurred and the patient has generalized sepsis, fevers, temperature, 103 F, chills and rigors, and confusion may be observed in association with hypotension and severe tachycardia. [laparoscopyhospital.com]
Patient presentation A 73-year-old man presented to the emergency room with severe abdominal pain, fever, chills, intense perspiration, and obstipation. [mdct.net]
The total postoperative complication rate was 17%, which included wound infection, bleeding, subhepatic abscess, cystic duct stump leak, common bile duct injury and pneumonia. Postoperative mortality was 2.6%. [ncbi.nlm.nih.gov]
For patients with complications (eg, intra-abdominal infections, wound infections, sepsis), therapy and follow-up care are patient specific and, therefore, individualized. [emedicine.medscape.com]
The postoperative complication rate regardless of approach either open of laparoscopic surgery for empyema from the gallbladder is 10-20% and includes wound infection, bleeding, subhepatic abscess, cystic stump leak, common bile duct injury, and systemic [laparoscopyhospital.com]
Other symptoms were poor appetite, nausea, vomiting and general malaise for one week. [austinpublishinggroup.com]
But in malignancy, patients may present with weakness, malaise, anorexia and a palpable right upper quadrant mass [ 1 ]. Elevated liver enzymes, especially alkaline phosphatase levels are commonly observed [ 3 ]. [omicsonline.org]
We present a 79-year-old African American woman resident in New York City with a medical history of diabetes mellitus who presented at the ED with constitutional symptoms and right upper quadrant pain of a few days duration. [scopemed.org]
Liver, Gall & Pancreas
[…] or perforation US : Markedly distended GB with echogenic pus in lumen – GB wall appears thickened – Sonographic Murphy sign often positive – Gallstones usually (but not always) present PATHOLOGY • GB hydrops caused by chronic GB outlet obstruction (most [clinicalgate.com]
The initial diagnosis of acute cholecystitis should be made based on clinical criteria, and in the setting of very high fever, abdominal pain that is accompanied by rebound tenderness (and a positive Murphy's sign - palpation of the inflamed gallbladder [symptoma.com]
She was tender and had a positive murphy’s sign on clinical examination coupled with tachycardia and a low-grade fever. [scopemed.org]
Positive Murphy sign (pain on compression of the GB with the ultrasonographic probe). Pericholecystic fluid in severe cases. Echo-poor halo in or around the GB wall or striated GB wall indicative of edema. GB distension. [wsoonli15.wordpress.com]
Physical examination shows abdominal distension, present hypoactive peristalsis, widespread tympanic percussion, voluntary muscle stiffness, painful on palpation of the entire abdomen, positive Murphy’s sign and rebound, with tachycardia 130 bpm, tachypnea [new.medigraphic.com]
Management Biliary Colic Initial Management Patients with biliary colic should be prescribed analgesia, typically NSAIDs and PRN opioids, along with an appropriate antiemetic. [teachmesurgery.com]
Recurrent biliary colic equals chronic cholecystitis. [rcemlearning.co.uk]
Gallstones may cause acute or chronic cholecystitis, biliary colic, pancreatitis or obstructive jaundice. Biliary colic is the most common presentation, caused by a gallstone impacting in the cystic duct or the ampulla of Vater. [patient.info]
Laparoscopic cholecystectomy for symptoms of biliary colic in the absence of gallstones. Am J Surg. 2003;186(1):1–3. 32. Henderson SO, Swadron S, Newton E. Comparison of intravenous ketorolac and meperidine in the treatment of biliary colic. [aafp.org]
Clinically, pre-operative diagnosis of acute inflammation and empyema or gangrene is often difficult because of the similarity of symptoms with biliary colic due to uncomplicated acute cholecystitis. 7-9 Biliary colic is a self-limiting transient obstruction [jpma.org.pk]
Physicians need to conduct a thorough clinical assessment through a detailed patient history and a comprehensive physical examination. The initial diagnosis of acute cholecystitis should be made based on clinical criteria, and in the setting of very high fever, abdominal pain that is accompanied by rebound tenderness (and a positive Murphy's sign - palpation of the inflamed gallbladder during inspiration that results in pain), as well as poor general condition, can point to gallbladder empyema  . Imaging studies, however, are the cornerstone in visualizing gallbladder empyema and establishing a firm diagnosis   . Abdominal ultrasonography (US), regarded as the first-line study in patients with hepatobiliary system pathology, will be able to identify gallstones, and thus raise valid suspicion, but more advanced methods, such as computed tomography (CT) and magnetic resonance imaging (MRI), may be necessary to make a definite diagnosis   . In addition to gallstones, thickening of the gallbladder wall, distension, and reactive hyperemia are other notable findings on the US and CT . MRI, on the other hand, is a superior method compared to US and CT, as it can discriminate pus and bile on T2-weighed studies, in which case percutaneous needle aspiration of pus and subsequent microbiological investigation might be recommended to reveal the underlying bacterial microorganism responsible for the infection  . Apart from significant leukocytosis, other laboratory findings are nonspecific  .
GB empyema is a life-threatening complication which should be kept as a possibility while evaluating patients with neutropaenia with pain abdomen localised to right hypochondrium as early diagnosis and treatment can lead to better outcomes. [ncbi.nlm.nih.gov]
The treatment can be surgical laparoscopic decompression and resection of the affected gallbladder is the criterion standard of therapy. [laparoscopyhospital.com]
DISCLAIMER: All material available on eHealthMe.com is for informational purposes only, and is not a substitute for medical advice, diagnosis, or treatment provided by a qualified healthcare provider. [ehealthme.com]
Key words: pyogenic hepatic abscess gallbladder, pyogenic abscess of the liver, pyogenic liver abscess, pyogenic hepatic abscess treatment, pyogenic hepatic abscess drainage [scopemed.org]
Treatment and prognosis Management options for suppurative cholecystitis include both emergent cholecystectomy and percutaneous catheter drainage, also termed percutaneous cholecystostomy (which can later be followed by a cholecystectomy) 1,5-6. [radiopaedia.org]
Prognosis If treated early, otherwise healthy patients have a full recovery and return to normal activity. [emedicine.medscape.com]
Prognosis after surgical removal of the gallbladder is very good. Very few people experience side effects from this procedure, while the rest do not need to make any changes to their lifestyle after this procedure. [ahealthgroup.com]
Prognosis The prognosis for recovery is generally good, except in those cases with complications, such as a brain abscess or blood poisoning, or cases caused by certain types of streptococci. [encyclopedia.com]
Etiology The most frequent etiology of empyema of the gallbladder is unresolved acute calculous cholecystitis in the face of contaminated bile. [emedicine.medscape.com]
Alltogether the commonest etiology of empyema of the gallbladder is unresolved acute calculous cholecystitis when confronted with contaminated bile. [laparoscopyhospital.com]
This is a surgical emergency which requires prompt treatment with antibiotics and urgent aspiration/removal of the gallbladder to reduce the risk of septic shock.    Etiology Frequently empyema of the gallbladder is associated with calculus cholecystitis [statpearls.com]
Epidemiology International The true incidence of empyema of the gallbladder associated with acute cholecystitis is difficult to assess, although findings from limited series indicate a range of 5-15%. [emedicine.medscape.com]
CVD Epidemiology Newsletter, 36, 116, 1984 ISSN PT02271108, no IF, no Citation Index 2. [gomppublic.uniroma1.it]
Empyema can also occur in calculus cholecystitis.   Epidemiology Empyema of the gallbladder is estimated to occur in 5 % to 15% of cases diagnosed to have acute cholecystitis. [statpearls.com]
Diehl Epidemiology of gallbladder cancer: a synthesis of recent data JNCI, 65 (1990), pp. 1209-1213 [10.] I. Roa, J.C. Araya, T. [elsevier.es]
Pathophysiology In the bacterially contaminated gallbladder, the stagnation and marked inflammation associated with acute cholecystitis fills the gallbladder lumen with exudative material principally comprised of frank pus. [emedicine.medscape.com]
The incidence of postoperative complications regardless of the surgical approach is estimated to be 10% to 20%.  Pathophysiology The stagnant bile due to cystic duct obstruction in the background of gallstone disease can become infected. [statpearls.com]
Pathophysiology Figure 1 – The biliary system, which transports bile from the gallbladder to the duodenum. Bile is formed from cholesterol, phospholipids, and bile pigments (products of haemoglobin metabolism). [teachmesurgery.com]
Subjects with diabetes mellitus, chronic renal disease, and aplastic anemia have a predisposition for this infection.[ 4 ] To understand the pathophysiology of PPT, it is important to know the anatomy of diploic veins. [thieme-connect.com]
The gallbladder neck is usually obstructed by a calculus (or rarely from a malignant mass such as an underlying cholangiocarcinoma ) which prevents pus from draining through the cystic duct 5. [radiopaedia.org]
Seite 290 - Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: A meta-analysis. Hepatology 1999; 29: 1655-61 6. [books.google.de]
Early and prompt surgical intervention in the form of cholecystectomy if not feasible, cholecystostomy prevents high morbidity and rare mortality. [statpearls.com]
Abstract Empyema of the gallbladder develops when the gallbladder neck is obstructed in the presence of infection, preventing pus from draining via the cystic duct. [ijri.org]
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