Gallbladder Empyema vs. Mucocele

Gallbladder Empyema vs. Mucocele

Both gallbladder empyema and mucocele are complications of gallbladder obstruction, typically related to cholelithiasis (gallstones). However, they differ in severity, contents, and urgency of treatment.

🦠 Gallbladder Empyema

Definition:
A gallbladder empyema is a severe form of acute cholecystitis in which the gallbladder becomes filled with pus, usually due to bacterial infection following cystic duct obstruction.

⚠️ Key Features:

• Pus-filled gallbladder
• Caused by superinfected gallbladder contents
• Often follows acute cholecystitis
• High risk of perforation, sepsis

🧪 Clinical Presentation:

• Severe right upper quadrant pain
• Fever, chills
• Toxic appearance
• Leukocytosis
• Tender, possibly palpable mass in the RUQ

🧬 Common Organisms:

• E. coli, Klebsiella, Enterococcus, Bacteroides

📷 Imaging:

• Ultrasound/CT scan:
  • Enlarged gallbladder
  • Thickened wall
  • Internal echoes (pus)
  • Pericholecystic fluid

💊 Management:

• Urgent surgical intervention: Usually cholecystectomy
• If patient unstable: Percutaneous cholecystostomy + IV antibiotics
• Broad-spectrum antibiotics (e.g., pip-tazo, ceftriaxone + metronidazole)

💧 Gallbladder Mucocele

Definition:
A mucocele is a distended, mucus-filled gallbladder, usually due to chronic cystic duct obstruction without infection.

⚠️ Key Features:

• Mucus or clear fluid accumulation (not pus)
• Often asymptomatic or mildly symptomatic
• Sterile contents
• Risk of compression or perforation if untreated

🧪 Clinical Presentation:

• Often incidental finding
• May have vague abdominal discomfort
• No signs of infection (no fever, systemic symptoms)

📷 Imaging:

• Enlarged gallbladder with anechoic contents
• Thin walls
• No signs of inflammation or infection

💊 Management:

• Elective cholecystectomy
• No need for emergency surgery unless complications arise

🔍 Summary Table: