Empyema of gallbladder in an infant.

Abstract

Empyema of gallbladder in an infant Although acute cholecystitis has been described in the past in published reports as a complication of scarlet fever and typhoid (Swing and Bullowa, 1938; Reid and Montgomery, 1920), and perforation of the gallbladder has been noted in infants (Prevot and Babut, 1971), empyema of the gallbladder remains rare. Case report A female, birthweight 3 35 kg after a normal pregnancy, was bottle fed and was well until the 10th day of life when she developed a paronychia of the left thumb and an infected spot on her back for which no treatment was given. At age one month the baby was admitted to hospital with a 3-day history of fever up to 39°C and feeding poorly. On examination the liver was palpable 1 cm below the costal margin. The white cell count was 17 000/mm3, of which 46% were neutrophils. Blood and CSF cultures were sterile. Treatment with ampicillin and flucloxacillin was given by injection. Her temperature settled and feeding improved. On the third day after admission a tender hard mass was noted apparently arising from the medial third of the liver. Further investigations showed that Hb had dropped from 10 3 g/dl to 7-6 g. Plasma bilirubin was 0 3 mg/100 ml; plasma glutamic oxaloacetic transaminase 14 IU/l; plasma glutamic pyruvic transaminase 10 IU/l; alkaline phosphatase 15 KA units/ 100 ml. The control film (Fig. 1) of the otherwise normal intravenous pyelogram revealed a mass continuous with FIG. 1.-Plain film of upper abdomen with mass and liver edge marked and liver scan superimposed.

Focal Bacterial Infections

“…The literature has documented about 25 cases, of which 9 were seen in association with an epidemic of neonatal enteritis caused by Salmonella enteritidis [111]. Of the remaining infants, 16 were the subjects of isolated case reports [24,103,[112][113][114][115][116][117][118][119][120][121][122][123], and 3 died of other causes with inflammatory changes in the gallbladder described as an incidental finding at autopsy [81,95,124]. A tissue diagnosis of "chronic cholecystitis" was established in an infant whose biliary disease apparently began at 6 days of age [125].…”

“…Organisms that have been isolated from gallbladder contents or tissue include E. coli [114][115][116]123], Serratia marcescens [103,117], Pseudomonas species [115], Streptococcus faecalis [123], viridans streptococci [121], S. aureus [123], and Clostridium welchii [123]. "Gram-positive cocci" were identified by Gram stain in one patient [113].…”