Empyema of the gallbladder

A condition in which a large amount of purulent discharge accumulates in the gallbladder without the possibility of their release is called empyema of the gallbladder. In the development of this pathology, a bacterial infection and blockage of the cystic duct play a role. The disease manifests itself in severe pain, high fever and growing signs of intoxication.

Empyema of the gallbladder is most often one of the adverse consequences of an acute inflammatory process - cholecystitis. The main difference between empyema and purulent cholecystitis is a violation of the outflow of bile due to obstructive blockage of the duct. Complication occurs in about 10% of patients with acute cholecystitis. [1]

Epidemiology

It is rather difficult to trace the real extent of the gallbladder empyema. However, according to information obtained in the course of several studies, the appearance of this complication is observed in about 5-15% of patients with cholecystitis. The most common cause of the development of pathology is the unresolved acute form of calculous cholecystitis.

Empyema of the gallbladder is one of the serious complications of acute cholecystitis. Other possible complications include gangrenous cholecystitis, dropsy, and perforation of the gallbladder. Perforation develops in about 6-12% of cases of acute cholecystitis, the mortality rate reaches 20-24% (while with gangrenous cholecystitis - 20%).

Empyema of the gallbladder is more common in people over 50, but the disease occurs at a younger age. Elderly and senile patients make up about 45-50% of the total number of cases. Men and women get sick with about the same frequency. [2]

Causes of the empyema of the gallbladder

Empyema of the gallbladder is not a primary disease: it is always secondary and occurs as a complication of some other, initial pathology. Basically, the reasons for the appearance of empyema are:

• acute inflammatory processes in the biliary system (cholecystitis with or without stones formation), which create obstacles for the excretion of bile, leading to stagnation and increased growth of bacterial flora; [3]
• tumor processes, squeezing the bile duct, preventing the excretion of bile.

The development of empyema is most often provoked by the following types of microorganisms:

• Escherichia koli;
• klebsiella pneumonia;
• streptococcus fecalis;
• bacteroids;
• clostridium spices.

Empyema of the gallbladder develops faster in patients suffering from obesity, diabetes mellitus, immunodeficiency states and hemoglobinopathies, as well as biliary carcinoma.

In the pathogenesis, the role of the body's allergic mood is also taken into account. Local allergic effects on the biliary tract of bacterial toxins, medicines, chemicals aggravate the already impaired organ function. Parasitic invasions (in particular, opisthorchiasis) can cause the development of cholecystitis, increase the virulence of bacteria, contribute to allergic manifestations, motility disorders and the development of congestion. [4]

Risk factors

Empyema of the gallbladder occurs as a result of the direct causes of an acute inflammatory process - cholecystitis. However, one should not ignore other disorders of the body's functions that can become a catalyst - a trigger for the development of inflammation. [5]

These risk factors include:

• frequent or chronic otolaryngological and respiratory diseases, including sinusitis, bronchitis, sinusitis, pneumonia, etc.;
• chronic or acute inflammatory processes of the digestive system (enterocolitis, appendicitis, microflora disorders in the intestine, etc.;
• parasitic diseases, helminthiases;
• infections of the reproductive and urinary system (pyelonephritis, salpingo-oophoritis, cystitis, prostatitis, etc.;
• dyskinesia of the biliary tract, disorders of the gallbladder tone, cholelithiasis;
• unhealthy diet (especially - regular overeating or starvation, as well as the abuse of spicy, fatty and fried foods);
• autoimmune diseases;
• tumors;
• arterial hypertension, diabetes mellitus and other pathologies that can indirectly disrupt the blood supply to the hepatobiliary system;
• hormonal changes, including during pregnancy;
• obesity, metabolic disorders;
• alcohol and tobacco abuse;
• severe or frequent allergic reactions;
• predominantly sedentary lifestyle;
• genetic predisposition.

According to statistics, a considerable part of cases of acute cholecystitis, which can provoke the development of empyema of the gallbladder, occurs against the background of the presence of gallstones - stones. Cholelithiasis is one of the leading risk factors for the onset of the disease.

Another factor that is rarely voiced by experts is a prolonged difficult labor in a woman, which can cause damage to the gall organ and significantly increase the likelihood of the formation of an inflammatory process already in the early postpartum stage.

Bladder injuries can occur not only during childbirth, but also in everyday life. In this case, almost any mechanical damage to the abdominal cavity becomes dangerous, and especially to the area of the right hypochondrium.

Uncompensated diabetes mellitus increases the risk of inflammation and damage to the biliary system.

Common prerequisites for biliary dysfunction can be nutritional disorders, non-compliance with the diet, overeating or too little food intake, excessive consumption of fried and fatty foods, alcohol, as well as psychoemotional, allergic and other negative phenomena, including infectious pathologies.

During the examination of practically healthy volunteers, experts determined that the indicator of the volume of the gallbladder on an empty stomach directly correlates with the weight of a person. But violations of the motor function of the biliary system were found only in people with excess weight and increased bladder volume on an empty stomach, which indicates the involvement of obesity in the development of disorders from the biliary system. Some scientists associate the development of pathology with vitamin D ₂ deficiency  and metabolic disorders.

Pathogenesis

Empyema of the gallbladder occurs against the background of blocked excretion of bile and the addition of an infectious component. The cause of blockage can be the wedging of calculi into the cystic neck, blockage of the duct by a bile clot, compression by the nearby tumor process. Acute cholecystitis becomes the triggering factor. [6]

Biliary inflammation develops when an infection enters - through the bloodstream, lymph flow or from the intestinal cavity. If the motility of the bile duct is disturbed, then microorganisms can enter the biliary system from the intestine.

The presence of stones, kinks or narrowing of the duct leads to stagnation of bile in the organ. In about 90% of cases, acute cholecystitis occurs due to gallstone disease. As a result of blocking the excretion of bile, intravesical pressure increases, the walls stretch, and local blood circulation is impeded. In the future, with an increase in the inflammatory process, the walls of the bladder are necrotic or burst, which entails the development of a corresponding complication.

The provoking links in the complex development of cholecystitis and empyema of the gallbladder can be:

• the use of mainly animal fats and carbohydrates, against the background of insufficient intake of proteins and plant fibers;
• low-calorie diet with rapid weight loss, eating disorders (alternation of fasting and overeating);
• hereditary factors, genetic constitutional features;
• diabetes mellitus, dyslipoproteinemia;
• pathologies of the liver, pancreas, biliary infections, hemolytic anemia, intestinal motility, prolonged period of parenteral nutrition;
• long-term use of contraceptives, diuretic drugs, as well as octreotide and ceftriaxone;
• chronic alcoholism, heavy smoking, prolonged physical inactivity;
• regular stress and conflicts;
• obesity.

Symptoms of the empyema of the gallbladder

The basic clinical symptoms of the development of empyema of the gallbladder are severe severe pain in the right hypochondrium, a sharp increase in temperature, signs of intoxication. These manifestations develop more often against the background of more smoothed symptoms of the acute course of cholecystitis.

It is possible to suspect that acute cholecystitis was complicated by empyema by the following characteristic symptoms:

• pronounced increase in pain;
• a sharp increase in temperature indicators up to 39-40 ° C;
• sometimes - yellowness of the sclera and visible mucous tissues;
• a sudden feeling of severe weakness;
• nausea, vomiting.

When probing the abdomen in the right hypochondrium, it is often possible to determine the increase and tension of the gallbladder, without a tendency to reduce symptoms. During palpation, the patient notes an increase in pain.

The slightest first signs of an exacerbation of pathology require immediate referral of the patient to the surgical department - for urgent diagnosis and determination of further treatment tactics. [7]

Especially carefully you should evaluate the deterioration of the condition of people suffering from any diseases of the hepatobiliary system. At the first suspicious manifestations, indicating an aggravation of the disease, it is necessary to urgently seek medical help, and in no case self-medicate. Especially and categorically contraindicated:

• offer the sick person food and alcoholic beverages;
• put a heating pad on the abdomen;
• flush the stomach and intestines;
• independently prescribe any medications.

Such symptoms can be called suspicious:

• sudden fever, chills;
• loss of interest in food;
• increased pain in the area of the projection of the liver;
• severe weakness;
• perspiration, dryness in the mouth;
• the appearance of nausea and vomiting when trying to eat.

In severe cases, with the addition of complications, there are signs of severe intoxication, up to loss of consciousness. There is a sharp decrease in blood pressure, tension of the abdominal muscles. [8]

With the development of such a complication as biliary peritonitis, the patient develops severe abdominal pain, as a result of which he takes the so-called "embryo" position, pressing his knees to his chest. There is an increase in heart rate up to 100-120 beats per minute, breathing quickens.

Severe intoxication is manifested by bloating, a sharp blanching of the skin. If the patient has not received medical assistance, then a phase of exhaustion begins: consciousness becomes cloudy, the skin turns yellow, and reactions to surrounding stimuli are lost. A similar condition can be called terminal: if untreated, death occurs. [9]

The main signs of empyema of the gallbladder are the following intensified symptoms:

• sharp persistent prolonged soreness in the zone of the projection of the liver;
• signs of irritation of the peritoneum, increased pain on a deep breath, with coughing and any motor activity;
• tension and soreness on palpation of the liver area;
• a sharp and strong increase in temperature indicators;
• increased sweating;
• yellowing of the sclera;
• lowering blood pressure;
• oppression of consciousness.

It is worth noting that in patients with diabetes mellitus or immunodeficiency states, the clinical picture may be erased. Therefore, such patients require particularly careful observation.

An auxiliary symptom is Murphy's symptom, which is checked as follows:

• put the hand of the left hand on the edge of the costal arch on the right side so that the second and fourth fingers are on the Kerr point (in the projection of the gallbladder on the anterior abdominal wall - the intersection of the right costal arch and the outer edge of the right rectus abdominis muscle);
• ask the patient to take a deep breath, while at the top of the inhalation, the person will feel a sharp pain in the liver (Murphy's symptom is positive).

Stages

Some experts in the field of gastroenterology talk about the possibility of staged development of diseases of the biliary system. These are the stages:

1. Dysfunction →
2. Dyscholia →
3. Cholecystitis →
4. Empyema, or cholelithiasis → empyema.

At the same time, such a staging is not generally accepted, since there are other pathogenetic factors that can become no less significant links in the development of empyema of the gallbladder. [10]

Complications and consequences

Empyema of the gallbladder is a serious danger for patients, since it can even end in death due to the development of complications. Strong stretching against the background of atrophic processes in the walls of the organ entail their perforation. Perforation, or tear, is of three types:

• breakthrough into the abdominal cavity, with further development of biliary peritonitis;
• subacute breakthrough with the development of a local abscess;
• the development of a cholecysto-intestinal fistula.

The clinical picture with perforation is the same as during acute cholecystitis. However, the general condition of patients is assessed as much more severe, not responding to the ongoing conservative treatment. After the first pathological signs appear, abdominal pain and fever are noted for several days. Patients refuse to eat. After the development of diffuse peritonitis, the diagnosis becomes clear. [11]

If the infectious component enters the circulatory system, patients develop generalized sepsis, which also carries a real threat to life.

Nevertheless, doctors consider the development of gangrene - that is, necrosis (necrosis) of the tissues of the organ - to be the main complication in empyema of the gallbladder. Most often, certain parts of it are exposed to necrosis - for example, the bottom. Death of the entire bladder is rare. [12]

So, most often such problems are found due to empyema of the gallbladder:

• necrosis of bladder tissue;
• perforation (hole formation, rupture of the walls of the organ with the development of biliary peritonitis);
• sepsis (the ingress of bacterial flora into the bloodstream, which entails the development of a systemic inflammatory reaction and subsequent damage to all or most organs).

Multiple organ failure, in turn, is fatal. [13]

Diagnostics of the empyema of the gallbladder

The fact of increased pain in the right hypochondrium against the background of an increase in body temperature in patients with acute cholecystitis gives reason to suspect the appearance of such a complication as empyema of the gallbladder. However, diagnostics to confirm the diagnosis is also necessary - first of all, to find out the causes of the pathology, to choose the correct treatment tactics.

During the collection of anamnesis, the doctor specifies how long ago certain disorders typical for empyema of the gallbladder were discovered. Next, the doctor performs palpation: with empyema, there are usually moderate pains in the right hypochondrium. Also checked is Murphy's sign, which is characterized by involuntary holding of breath during inhalation at the moment of pressing on the right hypochondrium. In patients with empyema of the gallbladder, this symptom gives a positive reaction.

If the disease is in an advanced stage, the doctor can feel a very painful and distended gallbladder.

Additionally, the patient is prescribed laboratory tests:

• A general clinical blood test for empyema of the gallbladder reveals an increased number of leukocytes (more than 15x10 ⁹ / l), a shift in the leukocyte formula to the left (even against the background of antibiotic therapy). Similar changes are characteristic of gangrenous cholecystitis.
• Blood biochemistry indicates that liver enzymes are in the reference range. This fact helps to distinguish gallbladder empyema from obstructive lesions of the distal segments of the biliary system. But in this situation there may be an exception to the rule: sometimes the gallbladder enlarged against the background of empyema presses on the common or hepatic bile duct. This may be accompanied by increased alkaline phosphatase activity and increased bilirubin levels.
• Microbiological testing can detect bacteremia, and an assessment of the bacteria's susceptibility to antibiotics helps to properly prescribe the appropriate antibacterial drugs.

Mandatory studies are:

• clinical analyzes of blood and urine;
• diastasis of urine;
• blood biochemistry with the determination of total bilirubin and fractions, total protein, glucose, amylase, total cholesterol, ALT, AST, ALP, GGTP);
• blood tests for HIV, RW, viral markers;
• assessment of the lipid spectrum of blood with the determination of the coefficient of atherogenicity.

Instrumental diagnostics, first of all, involves an ultrasound examination. Empyema of the gallbladder can manifest itself in different variations of the echographic picture. At the same time, the most common ultrasound signs include intense and sometimes uneven structural disorders, altered echogenicity and thickness of the organ walls - both along the perimeter and locally. An enlarged gallbladder, peri-vesicular fluid accumulation is found. Bile is heterogeneous, may have flakes, sediment and gaseous bubbles. [14]

When conducting ultrasound, it should be borne in mind that the echo pattern in empyema of the gallbladder can change quite quickly. A standard examination is performed using a convex probe. After the procedure, the doctor fills out a diagnostic protocol, in which he describes all the parameters and changes in the gallbladder (position, shape, size, condition of the walls, inclusions, contents in the lumen, the state of the surrounding tissue).

With regard to endoscopic examination - in particular, retrograde cholangiopancreatography - if empyema is suspected, it is not performed, so as not to waste time and to start surgical treatment as soon as possible.

Additionally, an X-ray examination may be prescribed, which consists in a plain radiography of the right hypochondrium, intravenous cholecystography. Less commonly, they resort to magnetic resonance imaging, which allows you to get a direct picture of the biliary system and pancreatic ducts.

Differential diagnosis

Empyema of the gallbladder, first of all, must be distinguished from dropsy of the same organ. Dropsy develops as a result of complete or partial obstruction of the bladder duct, as a result of which mucus and exudate accumulate in the cystic lumen. Dropsy occurs after the cessation of bile outflow. The main characteristics of the pathology are occlusion of the cystic neck or duct by calculus against the background of a small virulence of the bacterial flora. In the gallbladder, the constituent bile components are absorbed, microbes die, the contents of the bladder discolor and become mucous. During the physical examination of patients, it is possible to feel an enlarged, distended, painless gallbladder and its bottom. With a virulent infection, the cystic walls are thickened, pus forms in the cavity.

Ultrasound remains the main method of differential diagnosis. In the lumen of the organ, dense echo structures are considered that can move when changing the position of the body. Ultrasound transmits fairly reliable information - about 96-98%.

Auxiliary differential diagnosis is performed with perforated ulcer, acute appendicitis, acute intestinal obstruction, right-sided pneumonia, urolithiasis, myocardial infarction (cholecystocardial syndrome), as well as cholangitis, gangrenous or purulent cholecystitis.

To exclude diseases similar in clinical picture, it is possible to use the following methods of differential diagnosis:

• liver tests;
• measurements of pancreatic enzyme levels;
• abdominal ultrasonography;
• samples with cholecystokinin, etc.

Treatment of the empyema of the gallbladder

The main components of treatment for empyema of the gallbladder are urgent surgical decompression measures and cholecystectomy. Prescribing drugs is an auxiliary method, including antibiotic therapy.

Basic treatment directions:

• prevention of complications in the form of perforation, etc.;
• unconditional removal of the organ.

The first stage of treatment is an emergency decompression of the gallbladder, which is necessary to reduce the degree of compression of the surrounding tissues. If the patient has hemodynamic instability, or there are contraindications for surgical intervention (concomitant severe pathologies), then you can use the opportunity to conduct hepatic drainage of the gallbladder under the control of radiography, the essence of which is to eliminate exudate and pus from the organ. This procedure will allow decompression of the biliary tract, which will lead to a quick and pronounced improvement in the patient's well-being. But, nevertheless, such a measure cannot guarantee a complete victory over pathology and the prevention of septic complications. Given this, if there are no contraindications to surgery, it is imperative to carry out cholecystectomy - but only after stabilization of hemodynamic parameters.

After surgery and removal of the gallbladder, supportive care, including antibiotic therapy, is important. This stage should continue until the temperature readings return to normal and the level of leukocytes in the blood stabilizes. Antibiotics are prescribed based on the results of a study of the antibiotic resistance of a culture seeded from bile secretion. [15]

Further management of patients includes adherence to a rational diet, physical activity, sanitation of foci of infection. An important role is played by dispensary observation, subsequent spa therapy, psychological rehabilitation measures.

Medicines

Drug therapy begins immediately after the surgical intervention, which involves the removal of the gallbladder. Such treatment may include the following activities:

• Infusion therapy to eliminate intoxication and restore water-electrolyte and energy deficit.
• Antibacterial therapy:
  • Ciprofloxacin orally 500-750 mg twice a day for ten days.
  • Doxycycline orally or intravenously: on the first day, 200 mg / day is used, then - 100-200 mg / day, depending on the severity of the condition, for two weeks.
  • Erythromycin orally, on the first day - 400-600 mg, then 200-400 mg every six hours. The duration of admission can be from one to two weeks. The tablets are taken between meals.

To avoid adverse effects and side effects against the background of antibiotic therapy (dysbiosis, mycosis), an oral solution of Intraconazole is prescribed in an amount of 400 mg / day, for ten days.

• Oral cephalosporins - for example, Cefuroxime 250-500 mg twice a day after meals, for two weeks.
• Symptomatic drugs are used according to indications:
  • Cisapride (a gastroprokinetic drug that increases the motility of the upper gastrointestinal tract) is taken 10 mg up to 4 times a day, or Debridat 100-200 mg up to 4 times a day, or Meteospazmil 1 capsule three times a day, for at least two weeks.
  • Hofitol 2 tablets three times a day before meals, or Allohol 2 tablets up to 4 times a day after meals for at least a month.
  • Polyenzyme preparations, for three weeks before meals, 1-2 doses, for several weeks.
  • Antacids, one dose 1.5-2 hours after a meal.
  • Pain relievers, antispasmodic drugs, depending on the desired clinical effect.

Among the possible side effects of treatment, the most common are stool instability, abdominal pain, itching, and increased gas production. Such signs require correction of both medicinal prescriptions and diet.

Surgery

Cholecystectomy is a surgical procedure that involves the removal of the gallbladder, the organ in which bile accumulates, which forms in the liver and takes part in the digestive process.

Cholecystectomy is a mandatory method of treatment for the development of biliary empyema, and the operation must be urgent in order to prevent the appearance of life-threatening complications. In recent years, the intervention is carried out mainly by the laparoscopic method, using a laparoscope (a special device with a video camera) and specific instruments. [16]

Laparoscopic cholecystectomy is rarely accompanied by complications, although in rare cases, the likelihood of their development remains. Possible complications include:

• bleeding, blood clots;
• problems with the cardiovascular system;
• infection;
• damage to nearby organs (eg, small intestine, liver);
• pancreatitis;
• pneumonia.

The degree of risk of complications for the most part depends on the general state of human health, and on the initial causes of the development of acute cholecystitis.

Preparation for surgery includes the following points:

• assessment of hematological parameters and the state of vital organs;
• stabilization of hematological parameters.

All preparatory activities must be carried out within no more than two hours.

Cholecystectomy is performed using general anesthesia (intravenous). The operation itself is performed using a minimally invasive laparoscopic or traditional open method.

During laparoscopic surgery, the surgeon performs 2-4 punctures in the abdominal wall. A special tube equipped with a video camera is inserted into one of the punctures: the doctor has the opportunity to look at the monitor installed in the operating room and control the surgical instruments introduced through the remaining punctures from the abdominal cavity. Laparoscopic gallbladder removal takes about 1.5-2 hours.

Sometimes laparoscopy may not be possible, and the surgeon has to perform an open access operation. The intervention proceeds as follows. In the right segment of the abdominal cavity, closer to the costal arch, the doctor makes a 3-10 cm incision, lifts the tissue to release the liver, and then removes the gallbladder. After control cholangiography, stitches. The duration of an open cholecystectomy is one and a half to two hours. [17]

The patient is in the operating room or in the intensive care unit until the end of the anesthesia. Then he is transferred to a regular ward, the glee undergoes further recovery.

After laparoscopic cholecystectomy, the patient can be released home on the third or fourth day, depending on his condition. The indications for discharge are as follows: the patient can eat and drink, move independently, with a satisfactory general state of health and the absence of complications.

After open cholecystectomy, the patient remains in the hospital a little longer, until adequate recovery.

The postoperative period after cholecystectomy associated with empyema of the gallbladder is necessarily accompanied by antibiotic therapy. Antibiotics are prescribed until the level of leukocytes in the blood stabilizes: at first, antibacterial agents are administered by intravenous infusion, then they switch to taking drugs inside.

In the first few days, the patient is recommended to stay in bed, but the patient should periodically try to get up, which is necessary to prevent postoperative complications (such as pneumonia, adhesions, etc.). Before the gas passes, it is forbidden to eat: usually, gases begin to leave 24-48 hours after the operation. Then you can eat a little, starting with mashed soups, liquid mashed potatoes in water. After a while, liquid cereals, mashed vegetables and meat are introduced into the diet.

Prevention

Acute cholecystitis, a complication of which is empyema of the gallbladder, is one of the most common diseases of the gastrointestinal tract. Therefore, preventive measures, first of all, must be directed at preventing the development of an inflammatory disease of the organ. So, the occurrence of acute cholecystitis is most often triggered by an infection. Infectious agents enter the gallbladder in several ways:

• with blood;
• from the intestines;
• through the vessels of the lymphatic system.

With the lymph and blood flow, the infection enters the bladder if there are violations of the protective function of the liver. If there are malfunctions in the motor function of the bile duct, then microbes can enter from the intestines. The inflammatory process develops against the background of a violation of the motor function of the bladder and bile retention.

The presence of stones, lengthening and tortuosity of the cystic duct, or its narrowing lead to biliary stasis. With gallstone disease, the incidence of an acute inflammatory process is up to 90%. Due to the blockage of the duct by the stone, the ingress of bile into the intestine becomes impossible, as a result, the intravesical pressure rises, the walls stretch, the blood circulation is disturbed, which leads to the start of the inflammatory reaction.

What can be done to reduce the risk of acute cholecystitis and gallbladder empyema? Doctors give the following recommendations:

• eat fractionally, 5-6 times a day, without overeating and periods of hunger strikes;
• exclude fatty, fried, salty, too spicy foods;
• get rid of bad habits in the form of smoking and drinking alcohol;
• lead an active lifestyle (a sedentary lifestyle contributes to the formation of stagnation);
• monitor body weight, prevent the development of obesity.

The following foods are recommended to be excluded from the diet, especially in cases where there are risk factors for the development of empyema of the gallbladder:

• fried, spicy, salty, too sour and fatty foods;
• hot sauces and condiments (including mayonnaise, adjika, mustard, horseradish);
• heavy cream and sour cream, a large amount of butter;
• beans, beans, peas;
• coffee, spirits, cocoa, soda;
• chocolate, sweets, pastries;
• sour fruits, coarse-fiber vegetables.

It is important to timely treat any pathology of the digestive tract, infections of the reproductive and urinary system, diseases of the ENT organs. If suspicious symptoms appear, you should see a doctor as soon as possible.

Forecast

Empyema of the gallbladder can be fatal if the patient is not provided with timely medical care and surgery. A good prognosis can be said only if the pathology was detected on time, and the patient did not have perforation, necrotic and septic complications. With the development of peritonitis and generalized sepsis, the prognosis deteriorates sharply.

In general, the outcome of the pathology often depends on the age of the patient and the general state of his health.

Timely therapy with its early onset provides a favorable prognosis: treatment ends with a complete recovery of the patient and his return to his usual vigorous activity. [18]

Patients belonging to the elderly and senile age category, as well as patients with immunodeficiency states and severe comorbidities (for example, with decompensated diabetes mellitus) belong to a special risk group: progressive empyema in such patients can activate the development of septic complications, which are complex conditions that pose a threat to life. In addition, strong stretching and atrophic processes in the walls of the organ can cause their rupture (perforation), with the further formation of biliary peritonitis.

There is some risk in the form of postoperative complications: the operated empyema of the gallbladder can be complicated by wound infection, bleeding, and the development of a subhepatic abscess. However, timely medical assistance in the form of competent surgical and further rehabilitation treatment makes it possible to make the prognosis of the disease favorable.