Frequently asked questions about Empyema Gallbladder

What is Empyema Gallbladder?

In may patients with acute cholecystitis in the presence of bacteria containing bile the infection may progress to suppurative infection in which the infected gallbladder fills with purulent material, this complicated condition of cholecystitis is referred to as empyema of the gallbladder. In empyema gallbladder the underlying cause of cholecystitis involves obstruction of the cystic duct, which causes the buildup of infected fluid and thick oedematous gallbladder. In these complicated situation systemic antibiotics and urgent drainage or resection are required to reduce the incidence of complications of empyema and to avoid or treat associated sepsis.

Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy by Dr R K Mishra

How empyema gallbladder develop?

From the bacterially contaminated gallbladder empyema develops, the stagnation and marked bacterial inflammation related to acute cholecystitis fills the entire gallbladder lumen with exudative material principally made up of frank pus. This method might be linked to chronic calculous cholecystitis, sometime acalculous cholecystitis, or rarely the carcinoma in the gallbladder.

What are the complication of Empyema Gallbladder?

If this condition is not treated immediately, the generalized sepsis ensues, with rapid progression from the gallbladder to patchy gangrene, with multiple microperforation, macroperforation, or, rarely, it can create cholecystoduodenal fistula. Patients at increased risk for infected cholecystitis include more frequently the individuals with diabetes, immunosuppression, obesity, or hemoglobinopathies.

are the complication of surgery of Empyema Gallbladder?

The surgical rate of laparoscopic cholecystectomy procedures converted to an open procedure is really a lot higher in patients with empyema from the gallbladder. The postoperative complication rate for empyema in the gallbladder is 10-20% and includes port wound infection, bleeding, subhepatic abscess, cystic stump leak, common bile duct injury, and systemic complications, including acute renal failure and/or respiratory insufficiency connected with sepsis. To prevent Port wound infection endobag should be used to extract gallbladder as shown in the picture above.

Empyema Gallbladder
Extraction of Infected Gallbladder

Picture Showing use of Gloves Endobag to extract infected Gallbladder.

In case of empyema gallbladder the clinical reputation someone with empyema from the gallbladder is comparable to exactly what a patient with acute cholecystitis, from where the empyema derives. In case of empyema gallbladder because disease progresses, severe pain and associated high fever, chills, and in many cases rigors could possibly be reported. In patients with empyema gallbladder the diabetes or immunosuppression may exhibit few signs and symptoms.

Early sign of empyema gallbladder in case of acute cholecystitis on, abdominal examination findings are similar to those of patients with acute cholecystitis, with mild-to-moderate tenderness in the right upper abdomen of the patient and a positive Murphy sign ie, arrest of inspiration as the infected gallbladder descends to touch a hand previously placed deep in the mid right abdomen.

What is the best way to manage the case of empyema Gallbladder?

Antibiotic coverage is modified in case of empyema gallbladder by culture and sensitivity results along with the bacterial resistance encountered from hospital setting. Surgical urgent decompression could be the purpose of therapy for empyema of the gallbladder. In case of experienced hand laparoscopic cholecyectectomy can be carried out with special care of use of endobag to preven port wound infection. In patients who're hemodynamically unstable or perhaps individuals in whom laparoscopic surgery is contraindicated as a result of significant comorbid conditions, transhepatic drainage in the gallbladder and its decompression under radiologic guidance is a temporizing the situation or is considered as an alternative of final procedure. Though rapid and marked improvement within the patient's condition usually follows, complete resolution without further septic complication mandating further intervention is unpredictable.

In skilled laparoscopic surgeons hands, there is no increase in morbidity is observed in the incidence of laparoscopic surgical misadventure with empyema of the gallbladder. Despite the higher incidence of conversion to an open surgical procedure, laparoscopic cholecystectomy is quite reasonable to initially proceed with a laparoscopic procedure.

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