Gallbladder Empyema

Obtain right-upper-quadrant abdominal ultrasound as the initial confirmatory study in suspected acute cholecystitis or gallbladder empyema. Ultrasound should identify gallstones and assess gallbladder wall thickening and distension; examine in more than one position when needed to demonstrate mobile stones and posterior shadowing. WHO+1WHO[PDF] Infographics - World Health Organization (WHO)WHO[PDF] Good clinical diagnostic practice

Order CBC, C-reactive protein and/or procalcitonin to assess inflammatory burden, plus AST, bilirubin, and alkaline phosphatase to identify biochemical evidence of biliary obstruction. Jaundice is not usual in isolated cholecystitis; bilirubin elevation or cholestatic liver tests should redirect evaluation toward biliary tract obstruction or concurrent cholangitis. WHO+1WHO[PDF] Infographics - World Health Organization (WHO)WHO[PDF] Good clinical diagnostic practice

For hemodynamic instability, altered mentation, suspected sepsis, peritonitis, or concern for gangrene, perforation, abscess, or infection extending beyond the gallbladder wall, obtain urgent surgical and interventional radiology input while completing resuscitation and imaging. CT abdomen is appropriate when complications are suspected or ultrasound is nondiagnostic. WHO+3WHO[PDF] Infographics - World Health Organization (WHO)cdn clinicaltrials[PDF] a prospective, randomized, open-label, comparative study tocdn clinicaltrialsA PHASE 3 PROSPECTIVE, RANDOMIZED, ...cdn clinicaltrials[PDF] Clinical Study Protocol - ClinicalTrials.gov

Gallbladder empyema represents a complicated presentation of acute cholecystitis in which infected material is contained within the gallbladder. Findings of perforation, abscess, diffuse peritonitis, or spread beyond the gallbladder wall shift management to complicated intra-abdominal infection principles and strengthen the need for urgent drainage or surgery. cdn clinicaltrials+3cdn clinicaltrials[PDF] a prospective, randomized, open-label, comparative study tocdn clinicaltrialsA PHASE 3 PROSPECTIVE, RANDOMIZED, ...cdn clinicaltrials[PDF] Clinical Study Protocol - ClinicalTrials.govWHO[PDF] Essential Medicines List Antibiotic Book

Use CT when ultrasound does not establish the diagnosis or when the clinical course suggests gangrene, rupture, pericholecystic abscess, or another intra-abdominal process. Supportive CT, MRI, or ultrasound evidence of perforation or intraperitoneal abscess is used to define intra-abdominal infection requiring procedural source control. WHO+2WHO[PDF] Infographics - World Health Organization (WHO)cdn clinicaltrials[PDF] PF-06947386 Protocol C3591036 Final Protocol Amendment 1, 21 ...cdn clinicaltrials[PDF] a prospective, randomized, open-label, comparative study to

If bilirubin or alkaline phosphatase is elevated, do not assume this is solely from gallbladder empyema. Acute cholangitis involves the bile duct system and is managed with biliary drainage plus antibiotics, whereas cholecystitis requires gallbladder-directed source control. WHO+1WHO[PDF] Infographics - World Health Organization (WHO)WHO[PDF] Essential Medicines List Antibiotic Book

Start antimicrobial treatment promptly in gallbladder empyema while source control is arranged. Antimicrobial selection should be guided by illness severity, with broader-spectrum therapy used for severe presentations; local susceptibility patterns and patient-specific allergy, kidney function, prior antimicrobial exposure, and healthcare-associated infection risk should inform the empiric regimen. WHO+1WHO[PDF] Essential Medicines List Antibiotic BookPubMedPerioperative Antimicrobial Prophylaxis in Elective and High-Risk Laparoscopic Cholecystectomy: A Narrative Review

In complicated acute calculous cholecystitis or in patients at high risk for antimicrobial resistance—including immunocompromised patients and those with healthcare-associated infection—adapt the regimen to microbiologic results. Bile cultures are positive in approximately 29% to 54% of acute calculous cholecystitis cases, supporting culture collection when gallbladder drainage or surgery yields bile. PubMedPubMed2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis

Do not extend antibiotics solely because a cholecystostomy tube remains in place. After adequate cholecystectomy source control and clinical recovery, treatment can be stopped in uncomplicated cases; for critically ill patients with controlled and eliminated source, approximately 5 days is usually adequate. Persistent fever, inflammatory deterioration, organ dysfunction, or uncontrolled drainage should trigger reassessment for incomplete source control or an alternative infection source rather than automatic prolonged therapy. WHOWHO[PDF] Essential Medicines List Antibiotic Book

Laparoscopic cholecystectomy is the only definitive treatment for acute cholecystitis and has a central role in acute calculous cholecystitis management. For gallbladder empyema, involve surgery early and pursue cholecystectomy when physiologic status and operative risk permit; symptomatic or complicated gallstone disease is a standard indication for laparoscopic cholecystectomy. ScienceDirect+2ScienceDirectGallstones: Physiopathology and treatment of cholelithiasis (part 1)WHO[PDF] Essential Medicines List Antibiotic BookPubMed2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis

Percutaneous cholecystostomy is appropriate when surgery is contraindicated, when the patient is not suitable for immediate operation, or when stabilization is required before interval cholecystectomy. In a 145-patient empyema series, ultrasound- and fluoroscopy-guided percutaneous transhepatic gallbladder drainage was performed within 48 hours of acute cholecystitis diagnosis before subsequent laparoscopic cholecystectomy. Wiley+2WileyePosters - 2020 - BJS (British Journal of Surgery)PubMedPalliative percutaneous transhepatic gallbladder drainage of gallbladder empyema before laparoscopic cholecystectomy - PubMedPubMed2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis

When severe inflammation makes safe dissection uncertain, prioritize avoidance of bile duct injury rather than forcing total cholecystectomy. Conversion to open surgery, anterograde cholecystectomy, or subtotal cholecystectomy are recognized alternatives in hazardous pedicular inflammation. ScienceDirectScienceDirectGallstones: Physiopathology and treatment of cholelithiasis (part 1)

After cholecystectomy or gallbladder drainage, follow vital signs, mental status, abdominal examination, leukocyte count, CRP and/or procalcitonin, and liver tests when obstruction or cholangitis was suspected. Improvement supports narrowing or stopping antibiotics according to source-control status; worsening values or new organ dysfunction warrant repeat evaluation for persistent infection, abscess, bile leak, or an alternate diagnosis. WHO+1WHO[PDF] Infographics - World Health Organization (WHO)WHO[PDF] Essential Medicines List Antibiotic Book

For patients treated initially with percutaneous transhepatic drainage, document drain output and clinical response and coordinate surgical reassessment for definitive management when the patient becomes an acceptable operative candidate. Percutaneous drainage is a stabilizing option, whereas cholecystectomy remains the definitive treatment for cholecystitis. PubMed+2PubMedPalliative percutaneous transhepatic gallbladder drainage of gallbladder empyema before laparoscopic cholecystectomy - PubMedWHO[PDF] Essential Medicines List Antibiotic BookPubMed2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis

If pathology or intraoperative imaging suggests a focal mass or unusual wall thickening, ensure follow-up for possible gallbladder malignancy. Gallbladder carcinoma may present with focal wall thickening and may cause jaundice through biliary tract invasion. WHOWHO[PDF] Good clinical diagnostic practice