Gallbladder Empyema
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Acute cholecystitis in the presence of bacteria-containing bile may progress to suppurative infection in which the gallbladder fills with purulent material, a condition referred to as empyema of the gallbladder. (The underlying cause of cholecystitis involves obstruction of the cystic duct, which causes the buildup of infected fluid.) Systemic antibiotics and urgent drainage or resection are required to reduce the incidence of complications and to avoid or treat associated sepsis.
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. This process may be associated with calculous cholecystitis, acalculous cholecystitis, or carcinoma of the gallbladder. Left untreated, generalized sepsis ensues, with progression in the gallbladder to patchy gangrene, microperforation, macroperforation, or, rarely, cholecystoduodenal fistula. Patients at increased risk for cholecystitis include those with diabetes, immunosuppression, obesity, or hemoglobinopathies.
The most frequent etiology of empyema of the gallbladder is unresolved acute calculous cholecystitis in the face of contaminated bile. The most frequently isolated organisms include Escherichia coli, Klebsiella pneumoniae, Streptococcus faecalis, and anaerobes, including Bacteroides and Clostridia species. Suppurative inflammation ensues, tightly filling the gallbladder with purulent debris. Localized or free perforation occurs if drainage or resection is not performed at this juncture. Generalized sepsis frequently accompanies this progression.
A similar pattern is infrequently observed in association with acute acalculous cholecystitis. Rarely, obstruction of the distal common bile duct may result in pus formation within the extrahepatic biliary tree, which can then decompress into the gallbladder. This distends and infects that organ, with ensuing empyema.
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%.
American Indians and Central American Indians have an increased risk of cholelithiasis/cholecystitis, as do patients with hemoglobinopathies, such as sickle cell anemia (more likely in black persons).
If treated early, otherwise healthy patients have a full recovery and return to normal activity.
In patients of advanced age, those who are immunocompromised, or those with significant comorbid conditions (including patients with advanced diabetes mellitus, in whom the condition is more prevalent), the development of empyema of the gallbladder and the resultant sepsis constitute a serious life-threatening event. [1]
The rate of laparoscopic cholecystectomy procedures converted to an open procedure is significantly higher in patients with empyema of the gallbladder. The postoperative complication rate (regardless of approach) for empyema of the gallbladder is 10-20% and includes wound infection, bleeding, subhepatic abscess, cystic stump leak, common bile duct injury, and systemic complications, including acute renal failure and/or respiratory insufficiency associated with sepsis.
Progression to death is unusual in otherwise healthy individuals but may occur in patients of advanced age, in patients with compromised immunity, or in individuals with significant comorbid conditions.
The major complications associated with empyema of the gallbladder are localized or free perforation and/or generalized sepsis.
Possible surgical complications include the following:
Bleeding
Subhepatic and/or liver abscess
Cystic stump leak
Common bile duct injury
Cull JD, Velasco JM, Czubak A, Rice D, Brown EC. Management of acute cholecystitis: prevalence of percutaneous cholecystostomy and delayed cholecystectomy in the elderly. J Gastrointest Surg. 2014 Feb. 18 (2):328-33. [Medline].
Lee NK, Kim S, Kim DU, et al. Diffusion-weighted magnetic resonance imaging for non-neoplastic conditions in the hepatobiliary and pancreatic regions: pearls and potential pitfalls in imaging interpretation. Abdom Imaging. 2015 Mar. 40 (3):643-62. [Medline].
Nigri GR, Aurello P, Ramacciato G. An abdominal mass. J Gastrointest Surg. 2011 Oct. 15(10):1902-3. [Medline].
Kwon YJ, Ahn BK, Park HK, Lee KS, Lee KG. What is the optimal time for laparoscopic cholecystectomy in gallbladder empyema?. Surg Endosc. 2013 Oct. 27(10):3776-80. [Medline].
Philips JA, Lawes DA, Cook AJ, et al. The use of laparoscopic subtotal cholecystectomy for complicated cholelithiasis. Surg Endosc. 2008 Jul. 22 (7):1697-700. [Medline].
Cox MR, Wilson TG, Luck AJ, Jeans PL, Padbury RT, Toouli J. Laparoscopic cholecystectomy for acute inflammation of the gallbladder. Ann Surg. 1993 Nov. 218(5):630-4. [Medline].
Eldar S, Eitan A, Bickel A, et al. The impact of patient delay and physician delay on the outcome of laparoscopic cholecystectomy for acute cholecystitis. Am J Surg. 1999 Oct. 178 (4):303-7. [Medline].
Empyema of the gallbladder – a forgotten disease. Lancet. 1984 Mar 17. 1 (8377):606. [Medline].
Fabre JM, Fagot H, Domergue J, et al. Laparoscopic cholecystectomy in complicated cholelithiasis. Surg Endosc. 1994 Oct. 8 (10):1198-201. [Medline].
Gharaibeh KI, Qasaimeh GR, Al-Heiss H. Effect of timing of surgery, type of inflammation, and sex on outcome of laparoscopic cholecystectomy for acute cholecystitis. J Laparoendosc Adv Surg Tech A. 2002 Jun. 12(3):193-8. [Medline].
Hemmer PH, Zeebregts CJ, Roelofsen E, Klaase JM. Gallbladder carcinoma presenting as an empyema with Staphylococcus aureus. ANZ J Surg. 2004 Apr. 74(4):289. [Medline].
Kato T, Yamagami T, Iida S. Percutaneous drainage under real-time computed tomography-fluoroscopy guidance. Hepatogastroenterology. 2005 Jul-Aug. 52(64):1048-52. [Medline].
Kiviluoto T, Sirén J, Luukkonen P, Kivilaakso E. Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet. 1998 Jan 31. 351(9099):321-5. [Medline].
Koperna T, Kisser M, Schulz F. Laparoscopic versus open treatment of patients with acute cholecystitis. Hepatogastroenterology. 1999 Mar-Apr. 46(26):753-7. [Medline].
Lee KT, Wong SR, Cheng JS, Ker CG, Sheen PC, Liu YE. Ultrasound-guided percutaneous cholecystostomy as an initial treatment for acute cholecystitis in elderly patients. Dig Surg. 1998. 15(4):328-32. [Medline].
Lim MS, Davaraj B, Kandasami P. Endoscopic drainage of empyema of the gallbladder through a concurrent cholecystoduodenal fistula. Asian J Surg. 2006 Jan. 29(1):55-7. [Medline].
Lo CM, Fan ST, Liu CL, et al. Early decision for conversion of laparoscopic to open cholecystectomy for treatment of acute cholecystitis. Am J Surg. 1997 Jun. 173(6):513-7. [Medline].
Thornton JR, Heaton KW, Espiner HJ, Eltringham WK. Empyema of the gall bladder – reappraisal of a neglected disease. Gut. 1983 Dec. 24(12):1183-5. [Medline].
Tseng LJ, Tsai CC, Mo LR, et al. Palliative percutaneous transhepatic gallbladder drainage of gallbladder empyema before laparoscopic cholecystectomy. Hepatogastroenterology. 2000 Jul-Aug. 47(34):932-6. [Medline].
Van Steenbergen W, Rigauts H, Ponette E, Peetermans W, Pelemans W, Fevery J. Percutaneous transhepatic cholecystostomy for acute complicated calculous cholecystitis in elderly patients. J Am Geriatr Soc. 1993 Feb. 41(2):157-62. [Medline].
Zheng QY, Johnson KR. Hearing loss associated with the modifier of deaf waddler (mdfw) locus corresponds with age-related hearing loss in 12 inbred strains of mice. Hear Res. 2001 Apr. 154(1-2):45-53. [Medline].
Abraham S, Rivero HG, Erlikh IV, Griffith LF, Kondamudi VK. Surgical and nonsurgical management of gallstones. Am Fam Physician. 2014 May 15. 89 (10):795-802. [Medline].
Warttig S, Ward S, Rogers G, Guideline Development Group. Diagnosis and management of gallstone disease: summary of NICE guidance. BMJ. 2014 Oct 30. 349:g6241. [Medline].
Demehri FR, Alam HB. Evidence-based management of common gallstone-related emergencies. J Intensive Care Med. 2016 Jan. 31 (1):3-13. [Medline].
Chathadi KV, Chandrasekhara V, Acosta RD, et al, for the ASGE Standards of Practice Committee. The role of ERCP in benign diseases of the biliary tract. Gastrointest Endosc. 2015 Apr. 81 (4):795-803. [Medline].
Benjamin Pace, MD, FACS Chief, Division of Breast Surgery, Department of Surgery, Queens Hospital Center; Associate Professor of Surgery, Icahn School of Medicine at Mount Sinai
Benjamin Pace, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, Medical Society of the State of New York
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James T O’Connor, MD Assistant Professor of Surgery, Icahn School of Medicine at Mount Sinai; Director of Surgery, Attending Surgeon, Queens Hospital Center
James T O’Connor, MD is a member of the following medical societies: American Medical Association, American Society of Colon and Rectal Surgeons, New York Society of Colon and Rectal Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons
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Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
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Praveen K Roy, MD, AGAF Chief of Gastroenterology, Presbyterian Hospital; Medical Director of Endoscopy, Presbyterian Medical Group; Adjunct Associate Research Scientist, Lovelace Respiratory Research Institute; Clinical Assistant Professor of Medicine, University of New Mexico School of Medicine
Praveen K Roy, MD, AGAF is a member of the following medical societies: American Gastroenterological Association, American Society for Gastrointestinal Endoscopy
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Maurice A Cerulli, MD, FACP, FACG, FASGE, AGAF Associate Professor of Clinical Medicine, Albert Einstein College of Medicine of Yeshiva University; Associate Professor of Clinical Medicine, Hofstra Medical School
Maurice A Cerulli, MD, FACP, FACG, FASGE, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, New York Society for Gastrointestinal Endoscopy, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy
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Sita Chokhavatia, MD, MBBS Associate Fellowship Director, Associate Professor, Department of Internal Medicine, Division of Gastroenterology, Mount Sinai School of Medicine
Sita Chokhavatia, MD, MBBS is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy
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Simmy Bank, MD Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine
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Bruce Morel, MD, FACS Clinical Assistant Professor, Department of Surgery, Mount Sinai School of Medicine
Bruce Morel, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, and Medical Society of the State of New York
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Gallbladder Empyema
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