# Cholangiocarcinoma of the Common Bile Duct Presenting as Empyema of the Gallbladder: A Rare Case Report

## TL;DR

A rare case of bile duct cancer presenting as a gallbladder infection is reported, emphasizing the need for thorough diagnosis in elderly patients.

## Contribution

This case report highlights a rare presentation of cholangiocarcinoma as empyema of the gallbladder and underscores the importance of imaging in diagnosis.

## Key findings

- Cholangiocarcinoma can present as empyema of the gallbladder, a rare and dangerous complication.
- Imaging, clinical history, and lab tests are crucial for diagnosing this unusual presentation.
- Management strategies must adapt for cholangiocarcinoma patients with complications like gallbladder perforation.

## Abstract

Cholangiocarcinoma of the common bile duct (CBD) presenting as empyema of the gallbladder is a rare entity that poses a risk of septicemia, septic shock, peritonitis, and abscess formation. This case report describes an elderly female presenting with pain in the right hypochondrium, a positive Murphy’s sign, and a history of regurgitation and constipation. It highlights the value of imaging in the early diagnosis of this rare presentation of underlying malignancy. The most common cause of empyema of the gallbladder is acute cholecystitis, followed by gallbladder neck obstruction by a calculus. This report discusses the important role of imaging supported by clinical history, examination, laboratory tests, and histopathological findings to diagnose this rare presentation of empyema of the gallbladder as a complication of underlying cholangiocarcinoma. Additionally, it briefly discusses the change in the management line for cholangiocarcinoma patients with complications such as gallbladder perforation and septicemia. The study concludes that the possibility of underlying bile duct malignancy cannot be overlooked in patients with similar symptoms, particularly among the elderly.