Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA.
Department of Surgery, University of South Florida, Tampa, FL, USA.
Am J Case Rep. 2020 Jul 31;21:e923040. doi: 10.12659/AJCR.923040.
BACKGROUND Empyema of the gallbladder is a complication of cholecystitis that can develop into sepsis if not treated promptly. Signs and symptoms of gallstone disease are nausea/vomiting, right upper quadrant tenderness, and a history of gallstone disease. With persistence of the obstruction, inflammation and bacterial overgrowth within the gallbladder lumen and tissue may lead to eventual venous congestion, pressure necrosis and even empyema of the gallbladder. CASE REPORT A 60-year old male presented with complaints of mild mid-epigastric pain radiating to the back. He denied previous similar history. CT and ultrasound of the abdomen revealed acute cholecystitis. During surgery, it was clear that the imaging did not accurately represent the severity of the infection and he was diagnosed with gallbladder empyema. Surgery was difficult but was successfully finished. The patient's symptoms and laboratory results normalized by post-operative day 3 and he was discharged. He had no further complications during 2-week follow up. CONCLUSIONS Physicians should keep the abnormal presentations of gallbladder empyema in mind and prepare themselves for a presentation different from imaging during surgery. Several prognostic factors including gallbladder wall thickness, gender, white cell count and diabetes mellitus have been associated with severe complicated cholecystitis and empyema of the gallbladder.
胆囊积脓是胆囊炎的一种并发症，如果不及时治疗，可能会发展为败血症。胆石病的症状和体征包括恶心/呕吐、右上腹压痛和胆石病病史。随着梗阻的持续存在，胆囊腔内和组织中的炎症和细菌过度生长可能导致最终静脉充血、压迫性坏死，甚至胆囊积脓。
一名 60 岁男性因轻度中上腹痛放射至背部就诊。他否认有类似的既往病史。腹部 CT 和超声显示急性胆囊炎。术中发现影像学检查不能准确反映感染的严重程度，诊断为胆囊积脓。手术难度较大，但最终成功完成。术后第 3 天，患者症状和实验室结果恢复正常并出院。在 2 周的随访中，他没有出现进一步的并发症。
医生应牢记胆囊积脓的异常表现，并为术中不同于影像学的表现做好准备。一些预后因素，包括胆囊壁厚度、性别、白细胞计数和糖尿病，与严重的复杂胆囊炎和胆囊积脓有关。
