What is Gallbladder Empyema?
Empyema of the gallbladder is the most serious type of acute cholecystitis, which is a sudden inflammation of the gallbladder. This condition typically develops from a worsening case of acute cholecystitis, set against a backdrop of stagnant bile and a blocked cystic duct (the tube that carries bile from the gallbladder). This situation is a surgical emergency that needs immediate action. Treatment involves the use of antibiotics and a rapid procedure to either drain or remove the gallbladder to lower the risk of septic shock, a life-threatening condition where an infection leads to dangerously low blood pressure.
What Causes Gallbladder Empyema?
Empyema of the gallbladder, a condition where the gallbladder gets filled with pus, often happens together with calculus cholecystitis, a situation where there’s a blockage in the tube connecting the gallbladder and the liver, causing bile to stagnate, or stop moving. This stagnant bile in the gallbladder can get infected with germs, leading to the development of pus in the already inflamed gallbladder. This results in the gallbladder becoming filled with fluid that seeped out of the blood vessels and often, pus.
Occasionally, empyema of the gallbladder occurs alongside problems like stones in the common bile duct, which is the tube that carries bile from the liver and gallbladder to the small intestine, or cancer of the gallbladder. It can also happen in cases of calculus cholecystitis, which is the inflammation of the gallbladder due to gallstones.
Germs that are often found in these cases include Clostridia, Bacteroides, Klebsiella, and Escherichia coli.
Risk Factors and Frequency for Gallbladder Empyema
Empyema of the gallbladder is a condition that happens in about 5 to 15% of people diagnosed with acute cholecystitis. This condition is more serious in older people and tends to affect more males than females. People with a higher risk for getting acute cholecystitis, such as those with conditions like diabetes, or those receiving treatments that weaken their immune system, or those with blood disorders, also have a higher chance of getting empyema of the gallbladder.
Death from this condition is rare, but it can happen in older people, those with a weak immune system, or those with multiple health problems. Also, it’s important to know that about 10 to 20% of patients may have complications after surgery, no matter the type of surgical method used.
Signs and Symptoms of Gallbladder Empyema
People suffering from gallbladder empyema exhibit symptoms similar to acute cholecystitis. A common symptom is tenderness in the upper right side of the abdomen accompanied by a distinct symptom known as Murphy’s sign. As the condition worsens, the gallbladder might be felt on touch and can be extremely tender. Other symptoms like high fever, severe chills, tremors, and signs of widespread infection can occur. This condition can be more complex and take longer to resolve in people who are taking drugs that suppress the immune system or those with diabetes, as these can often have less of the typical symptoms previously mentioned.
If the gallbladder ruptures, further symptoms such as rapid heart rate, fever, general infection, chills, and tenderness on the right upper side of the abdomen might develop. In severe cases, the swollen gallbladder might be felt upon touch.
Testing for Gallbladder Empyema
When a patient comes in with early-stage empyema, which is an infection in the body, the signs and symptoms may not be distinct enough to differentiate it from acute cholecystitis or inflammation of the gallbladder. Often, there is an increase in the number of white blood cells, which typically signals an infection. Doctors will usually order tests to check the health and function of the liver and kidneys, a blood clotting profile, and a complete blood count (CBC), which is a detailed analysis of blood components.
An ultrasound is often the first imaging technique used when examining gallbladder issues. Though it can’t confirm empyema, an ultrasound can raise suspicion when the gallbladder appears very swollen or has echogenic content, essentially reflectors of ultrasound waves, especially when gallstones are also present. If the ultrasound doesn’t provide the necessary information, a CT scan might be ordered. CT scan can reveal an enlarged or distended gallbladder with swollen walls and, occasionally, fluid accumulation around the gallbladder.
If diagnosing empyema is still challenging, an MRI scan may be helpful. A specific feature in the MRI, called a heavily T2 weighted sequence, can help distinguish pus from sludge or thick bile. An MRI can also reveal a separation of infected bile.
An increase in white blood cells, particularly more immature types, in someone with acute cholecystitis or gallbladder inflammation can suggest that the condition is worsening. Other related tests are liver enzyme levels, and PT (prothrombin time) and aPTT (activated partial thromboplastin time), which are measures of how long it takes blood to clot.
However, it’s important to realize that imaging findings alone may not be enough for an accurate diagnosis of empyema of the gallbladder. A correct final diagnosis depends on a combination of clinical examination, imaging results, and lab findings.
Treatment Options for Gallbladder Empyema
If you have an infected gallbladder, known as empyema of the gallbladder, it’s essential to get treatment quickly to prevent further health issues or even death. This usually involves taking antibiotics that can kill a wide range of bacteria, as well as getting fluids to help your body cope with the condition. The goal is to prepare your body for surgery where the gallbladder can be removed or drained as soon as possible.
Traditionally, surgeons would perform an open surgery to remove the gallbladder. However, these days, skilled surgeons can essentially accomplish the same goal using a method called laparoscopic surgery. This technique is less invasive, using small incisions and a camera to guide the surgery. But it won’t always be possible. If a surgeon comes across complications during laparoscopic surgery, they may need to switch to an open surgery. This happens more often when treating an infected gallbladder compared to a simple gallbladder inflammation, due to the added difficulties of working around inflamed tissue and limited visibility.
Sometimes it’s helpful to deflate the gallbladder before surgery. This can be done with the guidance of medical imaging or during the surgery itself. This can make the process of removing the gallbladder easier.
Regardless of the surgical approach, removing an infected gallbladder can sometimes lead to complications. These can include things like wound infection, bleeding, biliary leakage, and injury to the bile duct. You might also hear about a rare procedure called a subtotal cholecystectomy, which is only done if inflammation around the gallbladder is making the normal surgery too risky.
If you are a senior or too ill to undergo surgery because of other health conditions, there is also the option of a temporary drainage of the gallbladder. This is a minor procedure done with imaging guidance that tends to greatly improve the patient’s condition and can make a full gallbladder removal more manageable later on when the patient’s overall health improves.
The use of antibiotics to fight the gallbladder infection will usually continue until your fever subsides.
What else can Gallbladder Empyema be?
Cholecystitis, gallstones, and biliary colic are medical conditions related to the gallbladder and bile ducts. They can cause similar symptoms and may sometimes be confused with each other. Here’s a quick explanation of each:
- Cholecystitis: This is an inflammation of the gallbladder, often caused by gallstones blocking the ducts.
- Gallstones: These are hard particles that develop in the gallbladder. They can range in size from a grain of sand to a golf ball.
- Biliary colic: This term refers to the severe pain that occurs when gallstones block the bile ducts.
What to expect with Gallbladder Empyema
Empyema of the gallbladder, a condition where pus collects in the gallbladder, can be successfully addressed if treated early. However, older people, those with weakened immune systems, or people with diabetes might not recover as well compared to healthier individuals.
Also, there are higher chances of surgeons needing to switch from a less invasive surgical technique (laparoscopic) to a more traditional one (open cholecystectomy) when dealing with empyema. After the gallbladder surgery, complications may occur in about 2 to 20% of patients. These complications include infections at the surgical site, injury to the bile duct (a tube that carries bile from the liver to the small intestine), abscesses (pockets of infection) beneath the liver, leaks from the stump of the removed gallbladder, kidney failure, a severe lung condition known as acute respiratory distress syndrome, and life-threatening infection known as sepsis.
Possible Complications When Diagnosed with Gallbladder Empyema
Possible Side Effects:
- Infections of the surgical wound
- Bleeding
- Injury to the bile duct
- Abscess below the diaphragm
- Sudden kidney failure
- Leakage from the remnant of the cyst
- Widespread infection in the body (Sepsis)
Recovery from Gallbladder Empyema
After gallbladder surgery, patients need to take antibiotics given through an IV, or intravenous line, until their fever goes away and their white blood cell count (a primary indicator of infection) returns to normal. Most patients continue taking antibiotics once they go home, usually for about a week.
