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KONGRES NASIONAL (KONAS) PDSRI XIII

IMPENDING GALLBLADDER EMPYEMA


PERFORATION: A CASE REPORT
Melinda 1, Francisca Notopuro 2, Filipus Michael Yofrido 3, Hans
Cendikiawan 4
1
National Hospital, Surabaya, Indonesia
2
Department of Radiology, National Hospital, Surabaya, Indonesia
3
Faculty of Medicine, Widya Mandala Catholic University, Surabaya,
Indonesia
4
Department of Radiology, dr. Soetomo Hospital, Surabaya, Indonesia
ABSTRACT
Introduction :
Perforated gallbladder empyema is a rare but life-threatening
complication that occur most frequently as a result of acute
cholecystitis.

Case Report :
A 55-year-old man with history of cholelithiasis presented to
emergency department with abdominal pain for two days. On
abdominal examination, he exhibited positive Murphy’s sign.
Initial ultrasound (US) of the abdomen revealed cholelithiasis and
acute cholecystitis. A further magnetic resonance (MR) imaging
was performed and showed an impacted stone in the neck of
gallbladder (d=8.7mm); dilated gallbladder with multiple gall
stones (d=6-8mm) with irregular, thickening of the wall, and slight
inner wall defect suspected impending perforation. There was also
sludge in the gallbladder and common bile duct. Urgent laparotomy
and cholecystectomy were performed and revealed that the
gallbladder was filled with 50cc of pus and perforated at the fundus
during surgery.
Discussion :
Complications such as empyema, gangrenous cholecystitis, and
gallbladder perforation have been reported in 4-12% of all cases of
acute cholecystitis. This patient’s sequence of events that leads to
gallbladder empyema and perforation may have resulted from his
known gallstones. Occlusion of the cystic duct (most often by a

Emergency Radiology: Diagnostic & Therapeutic, Bali, 13-15 December 2018


KONGRES NASIONAL (KONAS) PDSRI XIII

calculus) can cause the retention of intraluminal secretions. The


stagnant bile in the gallbladder may progress to suppurative
infection filling the gallbladder with pus. As the intraluminal
pressure increases venous and lymphatic drainage, it leads to
vascular compromise to necrosis and perforation of the gallbladder.
US is the first modality to suspected acute gallbladder disorders.
When additional information is needed, MR imaging, including
MR cholangiopancreatography, can be of help. Multisequence MR
images have excellent tissue contrast and can provide a more
comprehensive and detailed evaluation of the biliary systems.
Conclusion :
A potentially fatal complication occurs when the gallbladder is
perforated. The radiologist should be aware of the imaging
spectrums that suggest complications of the acute cholecystitis.
Keywords : Gallbladder perforation, gallbladder empyema, acute
cholecystitis, cholelithiasis

Emergency Radiology: Diagnostic & Therapeutic, Bali, 13-15 December 2018