Acute Emphasematous Cholecystitis

Abstract

Emphysematous cholecystitis (EC) is an uncommon variant of acute cholecystitis and can be rapidly lethal. We report an extremely rare case of EC and we present the imaging features of this patient. An 80-year-old male presented with epigastric pain and fever. Abdominal computed tomography confirmed the presence of an air-liquid level in the gallbladder lumen, gas within the gallbladder and in its walls. Emergency open cholecystectomy revealed necrotic changes in the gallbladder. The patients postoperative course was uneventful. The mortality associated with non-emphysematous is 4% compared with 15% for EC due to the increased incidence of gallbladder wall gangrene and perforation. The pathophysiology of EC differs from that in acute calculous cholecystitis. Diagnosis is established when the CT scan reveals gas within the gallbladder or in its walls in the absence of an abnormal communication between the gastrointestinal tract and the biliary system. The standard treatment is emergent cholecystectomy and antibiotic therapy. It could conclude that surgeons should be aware of the existence of this kind of atypical presentation of cholecystitis. EC is a rare condition in which the abdominal computed tomograph proves to be a most useful tool. It is important to differentiate this rare pathologic feature of the gall bladder from other cholecystitis as the treatment is surgical rather than medical.




J Curr Surg. 2014;4(1):31-33
doi: http://dx.doi.org/10.14740/jcs216w