Diagnostic complexity in the older patient: an unusual presentation of advanced biliary disease. (18th June 2021)

• Record Type: Journal Article
• Authors: Hosty, Jennifer; Narramore, Ruth; Boothroyd, Matthew; Ramanath, Rekha
• Is Part Of: Age and ageing. Volume 50:Number 5(2021)
• Page Start: 1859
• Page End: 1860
• Publication Date: 2021-06-18
• Subjects: biliary -- empyema -- frailty -- sepsis -- comorbidity -- older people; Aging -- Periodicals; Geriatrics -- Periodicals; 618.97
• DOI: 10.1093/ageing/afab123
• Languages: English
• ISSNs: 0002-0729

Abstract

Abstract: Biliary disease is common in the older population, and gallbladder dysfunction and increased bile lithogenicity predispose to calculi formation. This case demonstrates an unusual presentation of gallbladder empyema. A 90-year-old male with metastatic prostate cancer presented with hypoactive delirium. With no localising features, normal liver function tests but persistently raised inflammatory markers, he was initially managed as a urinary tract infection. Chest wall discomfort and swelling over the right costal margin later developed. Abdominal imaging demonstrated a massive gallbladder empyema invaginating through the lower right rib cage, causing the superficial swelling. Pre-morbid status prevented cholecystectomy and he was managed conservatively with percutaneous cholecystostomy and antibiotics. He was discharged to 24-h care 2 weeks after diagnosis with a long-term drain.