Suspected empyema of the gallbladder

A 72 year old man presented with persistent right upper quadrant pain, fever, and lethargy. He had been treated for cholecystitis the previous week with intravenous antibiotics and then oral antibiotics.

On examination, he was pyrexial and had a tender palpable mass in his right upper quadrant. His white cell count was raised, at 20.6 x 109/L, with a predominance of neutrophilia, and liver function tests were normal except gamma-glutamyl tranferase of 154.

He was started on intravenous antibiotics for suspected empyema of the gallbladder. Ultrasound scan of the abdomen showed multiple gallstones and an 8 cm inflammatory mass adjacent to the gallbladder. A contrast enhanced computed tomography scan of the patient’s abdomen was performed, which confirmed a distended gallbladder with an abscess adjacent to the gallbladder fundus, which was suggestive of a contained gallbladder perforation.

An ultrasound guided drain was inserted to drain the collection and remained inside the