Empyema of the gallbladder.

There is fairly widespread belief that suppuration superimposed upon acute cholecystitis is a rather uncommon condition. Scanty information on this subject is found in the published literature. No doubt, the scarcity of data further reinforces this clinical impression. Yet, from the few studies available, a surprisingly high incidence (7-11%) is documented. We reviewed 518 patients who underwent emergency cholecystectomy and found 139 cases to have frank pus present within the gallbladder. The clinical presentation is often difficult to distinguish from that of acute cholecystitis but diagnosis is crucial to identify this potentially fatal surgical emergency. There are encouraging reports of specific ultrasonic features which can demonstrate the increased viscosity produced by the purulent and fibrinous content within the gallbladder.