Gallbladder empyema with percutaneous cholecystostomy

Case contributed by Ian Bickle
Diagnosis certain


Right upper quadrant pain, palpable gallbladder and sepsis.

Patient Data

Age: 80 years
Gender: Male

Distended gallbladder, with viscous content, highly suggestive of a gallbladder empyema.

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

No gallbladder perforation.

transhepatic percutaenous...


transhepatic percutaenous cholecystostomy performed.

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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