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We report the case of a 94 year-old-woman with a history of NYHA class III heart failure, arrhythmia and gallbladder disease, who underwent an endoscopic biliar sphincterotomy due to coledocholitiasis at the age of 88. A cholecystectomy was dismissed because of the patient’s comorbidity. The patient was admitted to our centre presenting with a onemonth history of abdominal pain, which had increased during the seven days prior to the admission. She also complained of a mass located in the right upper quadrant of her abdomen, which had become larger over the last 48 hours. She denied having had fever. Abdominal examination revealed an 11-cm mass in the right subcostal area, which was punctured and pus was obtained. The patient’s white blood cell count was 17.6 x 10 μL with 88.9% segments. Radiological examinations were normal. Abdominal computed tomography (CT) was performed, revealing a calculous gallbladder in close contact with the abdominal wall, where it was a collection of 10 x 6 x 8.6 cm with fluid, air and what seemed to be calculi. The findings were described as Empyema necessitatis due to cholecystitis (Fig. 1). Considering the comorbidity of the patient, an incision was performed and drainage of the abdominal wall mass was achieved. The patient made an uneventful recovery, and was fit for discharge 9 days postoperatively.

Empyema necessitatis in an elderly patient: A rare pathological entity in modern times