{ "schemaVersion": 2, "eyebrow": "Emergency General Surgery", "title": "Gallbladder Empyema", "summary": "Gallbladder empyema requires prompt confirmation of complicated acute cholecystitis, antimicrobial treatment, and definitive source control. Early laparoscopic cholecystectomy is preferred when operative risk is acceptable; image-guided gallbladder drainage is a bridge or alternative when surgery is unsafe.", "seoDescription": "Physician guide to diagnosing and managing gallbladder empyema, including imaging, cultures, early cholecystectomy, and percutaneous drainage.", "clinicalQuestion": "How should clinicians diagnose, stabilize, and achieve source control for suspected gallbladder empyema?", "specialty": "General Surgery", "audience": "U.S. physicians and medical trainees", "tags": [ "gallbladder empyema", "acute calculous cholecystitis", "percutaneous cholecystostomy", "laparoscopic cholecystectomy", "biliary infection", "source control" ], "keyTakeaways": [ "Treat gallbladder empyema as complicated acute cholecystitis: obtain abdominal ultrasound promptly, assess for sepsis and local complications, and plan source control rather than antibiotics alone. [14][22]", "Laparoscopic cholecystectomy is the definitive treatment when the patient can tolerate surgery; early laparoscopic cholecystectomy has a central role in acute calculous cholecystitis management. [23]", "Use percutaneous gallbladder drainage for patients unsuitable for immediate surgery or when operative risk precludes cholecystectomy; drainage can stabilize empyema before interval laparoscopic cholecystectomy. [11][20][23]", "Obtain blood cultures before antibiotics in severe disease when feasible, and send bile or gallbladder fluid for culture when drainage or surgery provides a specimen; tailor therapy in complicated disease or antimicrobial-resistance risk. [14][23]", "After adequate operative source control and clinical recovery, antibiotics may be stopped in uncomplicated cases; critically ill patients generally require about 5 days after source control. [22]" ], "sections": [ { "id": "triage-and-initial-actions", "eyebrow": "First hours", "heading": "Recognize empyema as a source-control problem", "intro": "Escalate beyond routine cholecystitis management when suppuration, sepsis, or local extension is suspected.", "paragraphs": [ "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. [14][16]", "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. [14][16]", "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. [14][17][18][19]" ], "bullets": [ "Draw blood cultures before antimicrobials when severe infection is suspected, if doing so does not delay treatment. [14]", "Send drained bile or operative gallbladder fluid for Gram stain, culture, and susceptibility testing when available. [14][19][23]", "Treat diffuse peritonitis, perforation, or abscess as complicated intra-abdominal infection requiring prompt source control. [17][18][19]" ], "subsections": [], "table": { "caption": "Findings that change the immediate evaluation and source-control pathway. [14][17][18][19]", "columns": [ "Clinical pattern", "Immediate tests or action", "Management implication" ], "rows": [ [ "Localized right-upper-quadrant process with gallstones, wall thickening, or distension", "Abdominal ultrasound; CBC, CRP and/or procalcitonin; AST, bilirubin, alkaline phosphatase. [14][16]", "Proceed to surgical assessment for definitive cholecystectomy when operative risk is acceptable. [22][23]" ], [ "Shock, altered mental status, or suspected sepsis", "Blood cultures before antibiotics when feasible; assess for sepsis and expedite source-control consultation. [14]", "Do not defer drainage or operative source control for prolonged diagnostic observation. [14][22]" ], [ "Peritonitis, suspected perforation, abscess, gangrene, or extension beyond the gallbladder wall", "CT abdomen if complication definition is needed; obtain urgent surgical evaluation. [14][17][18][19]", "Manage as complicated intra-abdominal infection with source control and culture-directed antimicrobial adjustment. [17][18][19][23]" ], [ "Jaundice or cholestatic liver-test abnormalities", "Assess for biliary obstruction or concurrent cholangitis rather than attributing jaundice to isolated cholecystitis. [14][16]", "Evaluate the biliary tract and determine whether biliary drainage is needed for cholangitis. [14][22]" ] ] } }, { "id": "confirm-complication-and-alternatives", "eyebrow": "Diagnostic branch points", "heading": "Define the anatomy that determines source control", "intro": "Imaging and operative findings distinguish an organ-confined empyema from perforated or disseminated infection.", "paragraphs": [ "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. [17][18][19][22]", "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. [14][15][17]", "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. [14][22]" ], "bullets": [ "Ultrasound wall thickening and gallbladder distension support cholecystitis but should be interpreted with the clinical syndrome and stone findings. [16]", "A focal gallbladder wall lesion or focal thickening raises concern for gallbladder carcinoma; jaundice can occur when carcinoma invades the bile tract. [16]", "When anatomy is hazardous because of severe pedicular inflammation, operative alternatives include subtotal cholecystectomy, anterograde cholecystectomy, or conversion to laparotomy. [7]" ], "subsections": [], "table": { "caption": "Source-control targets in biliary infection. [14][22]", "columns": [ "Condition", "Anatomic focus", "Primary procedural objective" ], "rows": [ [ "Gallbladder empyema", "Suppurative infection within the gallbladder. [20][22]", "Cholecystectomy when feasible; percutaneous transhepatic gallbladder drainage when immediate surgery is unsafe or as a bridge. [11][20][23]" ], [ "Perforated or abscess-forming cholecystitis", "Infection extends beyond the gallbladder wall or into the peritoneal cavity. [17][18][19]", "Urgent operative or percutaneous source control with microbiologic sampling. [15][17][19]" ], [ "Acute cholangitis", "Bile duct system. [14][22]", "Biliary drainage plus antimicrobial therapy. [22]" ] ] } }, { "id": "antimicrobial-management", "eyebrow": "Before and after source control", "heading": "Use antibiotics to support—not replace—drainage or surgery", "intro": "Choose empiric therapy according to clinical severity and refine therapy when cultures identify a pathogen.", "paragraphs": [ "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. [22][24]", "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. [23]", "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. [22]" ], "bullets": [ "Collect blood cultures in severe cases before antibiotics when feasible. [14]", "Culture bile or abdominal fluid obtained through a drain or operation, particularly in complicated infection or resistance risk. [14][23]", "Use local antimicrobial stewardship protocols for agent selection because the cited guidance supports severity-based breadth but does not specify a universal empiric drug regimen or dose. [22][24]" ], "subsections": [], "table": null }, { "id": "definitive-and-bridge-source-control", "eyebrow": "Procedural decisions", "heading": "Choose early cholecystectomy unless surgery is currently unsafe", "intro": "Separate high operative risk from true inability to undergo surgery.", "paragraphs": [ "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. [7][22][23]", "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. [11][20][23]", "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. [7]" ], "bullets": [ "Use percutaneous drainage as a bridge when immediate laparoscopic cholecystectomy carries prohibitive risk; reassess for interval definitive surgery after clinical stabilization. [20][23]", "Do not equate advanced age or comorbidity alone with nonsurgical status; distinguish high-risk patients from those genuinely unsuitable for surgery. [23]", "Escalate to urgent source control when imaging or examination identifies perforation, abscess, peritonitis, or infection beyond the gallbladder wall. [17][18][19]" ], "subsections": [], "table": { "caption": "Procedure selection for gallbladder empyema. [7][11][20][22][23]", "columns": [ "Clinical situation", "Preferred source-control approach", "Key tradeoff or next step" ], "rows": [ [ "Operative candidate with empyema", "Early laparoscopic cholecystectomy. [22][23]", "Provides definitive treatment; obtain bile culture if a specimen is available. [14][23]" ], [ "Immediate operation contraindicated or patient unsuitable for surgery", "Image-guided percutaneous cholecystostomy. [11][23]", "Achieves gallbladder decompression and infection control; reassess candidacy for interval cholecystectomy. [20][23]" ], [ "Severe inflammation with unsafe pedicle dissection", "Subtotal or anterograde cholecystectomy, or conversion to open surgery. [7]", "Use a bailout strategy rather than persist with hazardous dissection. [7]" ], [ "Perforation, abscess, or diffuse peritonitis", "Urgent operative and/or percutaneous source control based on anatomy and physiologic status. [17][18][19]", "Treat as complicated intra-abdominal infection and send procedural specimens for culture. [15][19]" ] ] } }, { "id": "post-source-control-monitoring", "eyebrow": "Reassessment", "heading": "Monitor response and identify failed source control", "intro": "Clinical recovery should drive de-escalation; deterioration should prompt anatomic reassessment.", "paragraphs": [ "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. [14][22]", "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. [20][22][23]", "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. [16]" ], "bullets": [ "Reimage with CT when recovery is not occurring as expected or when perforation, abscess, or another complication is suspected. [14][15]", "Use culture and susceptibility results to narrow treatment in complicated disease or antimicrobial-resistance risk. [23]", "Stop rather than reflexively continue antimicrobials after adequate source control and clinical recovery; use a longer course only when clinical severity and source-control adequacy justify it. [22]" ], "subsections": [], "table": null } ], "faq": [ { "question": "Is percutaneous cholecystostomy definitive therapy for gallbladder empyema?", "answer": "It is an appropriate alternative when surgery is contraindicated or a bridge for patients unsuitable for immediate operation, but cholecystectomy is the definitive treatment for acute cholecystitis. Reassess operative candidacy after stabilization. [11][20][22][23]" }, { "question": "When should bile cultures be obtained in gallbladder empyema?", "answer": "Send bile or gallbladder fluid obtained during drainage or surgery for culture and susceptibility testing, especially in complicated infection, immunocompromise, healthcare-associated infection, or other antimicrobial-resistance risk. 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Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Supplementary appendix - The Lancet", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/cms/10.1016/S1473-3099(24)00499-7/attachment/edc8e21b-1313-4948-ab36-8f15501b84e6/mmc1.pdf", "authors": "www.thelancet.com", "host": "www.thelancet.com", "snippet": "Cholecystitis with gangrenous rupture or perforation or progression of the infection beyond the gallbladder wall. Supportive radiologic imaging", "score": 0.3271097 }, { "number": 2, "title": "Early laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for acute cholecystitis | Scientific Reports", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-021-82089-4", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "Article \nCAS \nGoogle Scholar\n\nChoi, J. W., Park, S. H., Choi, S. Y., Kim, H. S. & Kim, T. H. Comparison of clinical result between early laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage for patients with complicated acute chol", "score": 0.28014886 }, { "number": 3, "title": "Multicenter external validation of a nomogram predicting conversion to open cholecystectomy during laparoscopic surgery for acute calculous cholecystitis: a cross-sectional study | Scientific Reports", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-025-03687-0", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "Demographic characteristics, corresponding physical examination findings, serum biomarkers, transabdominal ultrasound measurements, disease severity grading, and surgical data were collected for all patients. Demographic characteristics included gender, age, body mass index (BMI), hypertension statu", "score": 0.22321655 }, { "number": 4, "title": "Gallbladder Emptying - an overview | ScienceDirect Topics", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/immunology-and-microbiology/gallbladder-emptying", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "The Tokyo Guidelines for the diagnosis of acute cholangitis and acute cholecystitis were updated in 2013 (Boxes 13.5 and 13.6) and provide a detailed", "score": 0.5917474 }, { "number": 5, "title": "Management of complex acute biliary disease for the general surgeon: A narrative review - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0002961023001162", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### Am J Surg\n\n### Urgent endoscopic retrograde cholangiopancreatography with sphincterotomy versus conservative treatment in predicted severe acute gallstone pancreatitis (APEC): a multicentre randomised controlled trial\n\n### Lancet\n\n### Incidental finding of gallbladder carcinoma detected during o", "score": 0.5826579 }, { "number": 6, "title": "Technique and indications of percutaneous cholecystostomy in the management of cholecystitis in 2014 - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1878788614000939", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### J Vasc Interv Radiol\n\n### Use of cholecystostomy tubes in the management of patients with primary diagnosis of acute cholecystitis\n\n### J Am Coll Surg\n\n### Recommandations de Pratique Clinique. Prise en charge de la lithiase biliaire\n\n### New diagnostic criteria and severity assessment of acute ", "score": 0.4703723 }, { "number": 7, "title": "Gallstones: Physiopathology and treatment of cholelithiasis (part 1)", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S1878788626000743", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "acute cholecystitis, stone migration, cholangitis or acute pancreatitis. In the event of symptomatic complications, laparoscopic cholecystectomy is the standard treatment. In the absence of clinical evidence, however, a conservative attitude is generally recommended, except in situations involving a", "score": 0.466433 }, { "number": 8, "title": "3 Gastroenterological emergencies - Oxford Academic", "detail": "academic.oup.com", "url": "https://academic.oup.com/book/29868/chapter/253101210", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "Barium studies or MRI: may be may occur. Cholecystitis ± empyema and gangrene of gall bladder. May confirm diagnosis of gallstones ± biliary obstruction,", "score": 0.48352703 }, { "number": 9, "title": "Abstracts of the AUGIS Annual Scientific Meeting. Glasgow, UK, 8 ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/bjs/issue-pdf/112/Supplement_17/66146943", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "They also more frequently presented with complicated gallbladder disease, such as gangrenous cholecystitis (5.4% vs 2.3%, p<0.05) and gallbladder empyema (9.4%", "score": 0.22805373 }, { "number": 10, "title": "Preoperative MRI for predicting pathological changes associated ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/bjsopen/article/4/6/1137/6136131", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "This study aimed to assess the use of preoperative MRI in predicting pathological changes of the gallbladder associated with surgical", "score": 0.14281696 }, { "number": 11, "title": "ePosters - 2020 - BJS (British Journal of Surgery)", "detail": "bjssjournals.onlinelibrary.wiley.com", "url": "https://bjssjournals.onlinelibrary.wiley.com/doi/full/10.1002/bjs.12069", "authors": "bjssjournals.onlinelibrary.wiley.com", "host": "bjssjournals.onlinelibrary.wiley.com", "snippet": "NICE guidelines recommend percutaneous cholecystostomy to manage gallbladder empyema when surgery is contraindicated and conservative management", "score": 0.6914979 }, { "number": 12, "title": "Abstract - 2026 - Journal of Hepato-Biliary-Pancreatic Sciences", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1002/jhbp.70048", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "Conventional laparoscopic cholecystectomy is a treatment for benign gallbladder disease. percutaneous gallbladder drainage (PTGD) without", "score": 0.445506 }, { "number": 13, "title": "Abstract Journal General Surgery : ANZ Journal of Surgery - Ovid", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/pdf/10.1111/ans.15839", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "The aim of this study was to compare three doses antibiotic and standard antibiotic course (5‐day) in reducing the incidence of wound … gallbladder empyema or", "score": 0.4075462 }, { "number": 14, "title": "[PDF] Infographics - World Health Organization (WHO)", "detail": "cdn.who.int", "url": "https://cdn.who.int/media/docs/default-source/essential-medicines/eml-antibotic-book-infographics-draft.pdf?sfvrsn=44633b13_5&download=true", "authors": "cdn.who.int", "host": "cdn.who.int", "snippet": "uncertain • Abdominal ultrasound to confirm the diagnosis Microbiology Tests Severe Cases: • Blood cultures (ideally before starting antibiotics) • Microscopy and culture of abdominal fluid material and bile (if they can be drained) to adjust empiric antibiotic treatment Mild Uncomplicated Cases: • No", "score": 0.40797067 }, { "number": 15, "title": "[PDF] PF-06947386 Protocol C3591036 Final Protocol Amendment 1, 21 ...", "detail": "cdn.clinicaltrials.gov", "url": "https://cdn.clinicaltrials.gov/large-docs/12/NCT04927312/Prot_000.pdf", "authors": "cdn.clinicaltrials.gov", "host": "cdn.clinicaltrials.gov", "snippet": "radiographs, computed tomography scans, ultrasound, and/or magnetic resonance image scans with or without contrast. n. If a patient fails or relapses between scheduled visits, the assessment should be recorded as an unscheduled visit. o. All required documentation including surgical reports and imag", "score": 0.33241925 }, { "number": 16, "title": "[PDF] Good clinical diagnostic practice", "detail": "applications.emro.who.int", "url": "https://applications.emro.who.int/dsaf/dsa236.pdf", "authors": "applications.emro.who.int", "host": "applications.emro.who.int", "snippet": "bladder wall is usually thickened; in addition there may be distension of the gallbladder. Cholecystitis is normally not accompanied by jaundice. Miscellaneous disorders: The most common disorder of the gallbladder is “sludge” that is diagnosed by the presence of echogenic Examination of clinical sy", "score": 0.26350272 }, { "number": 17, "title": "[PDF] a prospective, randomized, open-label, comparative study to", "detail": "cdn.clinicaltrials.gov", "url": "https://cdn.clinicaltrials.gov/large-docs/44/NCT03580044/Prot_000.pdf", "authors": "cdn.clinicaltrials.gov", "host": "cdn.clinicaltrials.gov", "snippet": "all carbapenem non-susceptible pathogens are susceptible to the systemic antibiotic[s] received). 4.1.2. Additional Inclusion Criteria - cIAI Subjects 1. Subject must have a specimen obtained from an abdominal source during a surgical intervention within 7 days prior to screening from which a study-", "score": 0.21586311 }, { "number": 18, "title": "A PHASE 3 PROSPECTIVE, RANDOMIZED, ...", "detail": "cdn.clinicaltrials.gov", "url": "https://cdn.clinicaltrials.gov/large-docs/92/NCT03329092/Prot_000.pdf", "authors": "cdn.clinicaltrials.gov", "host": "cdn.clinicaltrials.gov", "snippet": "percutaneous drainage of an abscess, or laparoscopic surgery. Specimens from the surgical intervention must be sent for culture. Subjects who undergo a surgical procedure with complete fascial closure are appropriate for the study. The skin incision may be left open for purposes of wound management ", "score": 0.1816842 }, { "number": 19, "title": "[PDF] Clinical Study Protocol - ClinicalTrials.gov", "detail": "cdn.clinicaltrials.gov", "url": "https://cdn.clinicaltrials.gov/large-docs/46/NCT02168946/Prot_000.pdf", "authors": "cdn.clinicaltrials.gov", "host": "cdn.clinicaltrials.gov", "snippet": "open laparotomy, percutaneous drainage, or laparoscopic surgery) will be sent for microbiological evaluation, including gram stain, culture and susceptibility testing, and Carbavance susceptibility testing AND: Indication At least ONE of the following, either on intra-operative visualization of infe", "score": 0.12535442 }, { "number": 20, "title": "Palliative percutaneous transhepatic gallbladder drainage of gallbladder empyema before laparoscopic cholecystectomy - PubMed", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pubmed/11020851", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Title: Palliative percutaneous transhepatic gallbladder drainage of gallbladder empyema before laparoscopic cholecystectomy - PubMed\nAn official website of the United States government. **The .gov means it’s official.**. The **https://** ensures that you are connecting to the. official website and t", "score": 0.8302782 }, { "number": 21, "title": "Percutaneous cholecystostomy: an alternative to surgical cholecystostomy for acute cholecystitis?", "detail": "pubs.rsna.org", "url": "https://pubs.rsna.org/doi/abs/10.1148/radiology.173.2.2678261", "authors": "pubs.rsna.org", "host": "pubs.rsna.org", "snippet": "Percutaneous cholecystostomy: an alternative to surgical cholecystostomy for acute cholecystitis? Percutaneous cholecystostomy: an alternative to surgical cholecystostomy for acute cholecystitis? Emergency percutaneous cholecystostomy was successfully performed in 39 of 40 attempted procedures in 37", "score": 0.5084226 }, { "number": 22, "title": "[PDF] Essential Medicines List Antibiotic Book", "detail": "cdn.who.int", "url": "https://cdn.who.int/media/docs/default-source/essential-medicines/eml-antibiotic-book-draft.pdf", "authors": "cdn.who.int", "host": "cdn.who.int", "snippet": "perforation) is the most important surgical intervention. Cholecystectomy 88 (i.e. removal of the gallbladder) is the only definitive treatment and an antibiotic should be given 89 until the gallbladder is removed(275). After surgery, in uncomplicated cases, antibiotic treatment 90 can be stopped pr", "score": 0.47533798 }, { "number": 23, "title": "2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7643471", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "_What is the role of microbiological cultures and sensitivities in patients with ACC?_\n\n7.3 In patients with complicated ACC and patients at high risk for antimicrobial resistance, we recommend adapting the targeted antibiotic regimen to the results of microbiological analysis, ensuring adequate ant", "score": 0.6685563 }, { "number": 24, "title": "Perioperative Antimicrobial Prophylaxis in Elective and High-Risk Laparoscopic Cholecystectomy: A Narrative Review", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12916073", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "The laparoscopic technique for cholecystectomy has dramatically reduced infection risk . This shift has sparked an ongoing debate regarding the necessity of prophylaxis in low-risk elective cases, with some studies suggesting that antibiotics may be omitted entirely without increasing SSI rates [5,1", "score": 0.6426349 } ], "publishedAt": "2026-09-16T00:59:00.192027+00:00", "updatedAt": "2026-09-16T00:59:00.192027+00:00", "readingMinutes": 5, "slug": "gallbladder-empyema" }