also known as supportive cholecystitis is an uncommon complication of cholecystitis.........
also known as supportive cholecystitis is an uncommon complication of cholecystitis and refers to a situation where the gallbladder lumen is filled and distended by purulent material (pus). There is an increased incidence in those with diabetes and/or advanced atherosclerotic disease. The gallbladder neck is usually obstructed by a calculus (or rarely from a malignant mass such as an underlying carcinoma, which prevents bile and pus from draining through the cystic duct.
Patients with a gallbladder empyema may experience symptoms similar to those with acute uncomplicated cholecystitis (fever, chills, rigors, and right upper quadrant pain) and signs of sepsis.
Ultrasound may show the usual sonographic features of cholecystitis with added echogenic content within the gallbladder lumen. CT scan may show general imaging features of cholecystitis with added high-attenuating material (representing pus) within the distended gallbladder lumen. MRI sometimes may be helpful in distinguishing pus from sludge by using heavily T2 weighted sequences, which may show fluid-fluid levels with dependent layering of purulent bile.
Treatment: Management for empyema gall bladder is emergent cholecystectomy . Open cholecystectomy is of choice. Laparoscopic cholecystectomy may be done in less severe conditions, however, the rate of conversion of a laparoscopic cholecystectomy to an open procedure is considered greater than that with cases of uncomplicated acute cholecystitis. Gallbladder empyema is associated with a significant morbidity and mortality.