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A case of empyema of the gall bladder.

Ulster Medical Society
Publication Date
  • Research Article
  • Medicine


Ulster Med J 1981; SO: 129-132 A CASE OF EMPYEMA OF THE GALL BLADDER JAMES ELLIOTT, FRCS Waveney Hospital, Ballymena, Co Antrim Fistulae originating in the biliary tree are now rare',2,3,4,5. This has only occured since cholecystectomy, with or without exploration of the common bile duct, came to replace non-intervention or simple cholecystostomy. Even rarer are spontaneous external biliary fistulae 1,2. These arise in the biliary tract and, by devious routes, emerge at various sites on the body surface. Before they rupture through the epidermis they are referred to as empyema necessitatis of the gall bladder. About half present in the right hypochondrium as would be expected, with some appearing through previous cholecystostomy wounds. The remainder recorded in the English language literature have appeared at the left costal margin, the umbilicus (via the falciform ligament), the right flank, the right iliac fossa, the right groin and the right thigh1,2,3,4,5. The present case adds another site to this list. CASE REPORT A 33 year-old married woman was referred with a 12-month history of a small, painful, soft abdominal swelling. She had no history of dyspepsia. She had gross enlargement of both kidneys due to congenital polycystic disease, and had had a vaginal hysterectomy and left ovarian cystectomy two years previously. The swelling had already been opened once, as it was thought to be a haematoma related to her previous surgery. A cavity containing mucous fluid and grey calculi had been found. Unfortunately the calculi were mislaid, and so were not sent for analysis. The wound was closed and healed satisfactorily, however the swelling recurred about one month later, and it was at this stage that she presented to the Waveney Hospital. On examination, there was a 4cm. diameter, tender swelling, situated in the mid-line, equidistant from the umbilicus and the symphysis pubis. Due to the site of the swelling, what was known of its previous contents, and the fact that it had recurred, it was

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