Gallbladder empyema with percutaneous cholecystostomy

Case contributed by Dr Ian Bickle

Presentation

Right upper quadran pain, palpable gallbladder and sepsis.

Patient Data

Age: 80
Gender: Male
Modality: Ultrasound
Distended gallbladder, with viscous content, highly suggestive of a gallbladder empyema.

The gallbladder is grossly distended.  Calculi in the depdenent position.

No gallbladder perforation.

Ultrasound guided transhepatic percutaenous cholecystostomy performed.

Modality: Photo

240 mls of frank pus aspirated from the gallbladder.  Blood tinged at the end, very common at the base of hepatobiliary abscesses.  Further drainage on the ward in the next 24 hours, yielded a total of 330 mls of pus from the gallbladder!

Post percutaenous cholecystostomy.  The gallbladde is now collapsed and contains calculi.

The percutaenous drain's transhepatic approach is shown (best on T2 coronal oblique) with the pigtail within the gallbladder.

No common bile duct calculi.

Case Discussion

Gallbladder empyema is a clinical diagnosis, however imaging appearances can be highly suggestive.

There is a growing role for the initial treatment with a percutaenous cholecystostomy, particularly in those with multiple medical co-morbidities or poor surgical candidates.

Ideally a transhepatic approach is undertaken, with often remarkable and prompt improvement in the patients condition.

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Case Information

rID: 24329
Case created: 8th Aug 2013
Last edited: 28th Feb 2016
Inclusion in quiz mode: Included

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