46 F Sudden severe pain abdomen with vomiting mild fever. General condition normal TLC 17000,HB 11 gm/ dl,FBS 103, Y urea 31, Creatinine 0.9 TSH 3.4 USG Abdomen and pelvis. GB enlarged distended,large calculus of size 20 mm impacted in Hartmann ' s pouch. Clinical diagnosis: Empyema GB Lap cholecystectomy is done. Colot' triangle adhesions released with hydrodissection( use of sucction cannula and NS ) Surgery accomplished successfully. GB is sent for HP study.

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