A Rare Case of Emphysematous Cholecystitis

Khare, Supreet; Pujahari, Aswini Kumar

doi:10.7860/jcdr/2015/10972.6463

Cited by 5 publications

(12 citation statements)

References 9 publications

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“…In the literature, it has not been demonstrated the presence of a clear cause but a predominance of the male subject, unlike acute cholecystitis [2,6] Four out of six of our patients are male, which corroborates this statement. They also differ in pathophysiology [1,8]. In emphysematous cholecystitis, ischemia and gangrene of the gallbladder wall with gas encircling the gallbladder due to gas-producing microorganisms, namely E coli, Clostridium welchii, Clostridium Perfringens, Klebsiella, and streptococci [9] which are the most frequently encountered germs [2,9].…”

Section: Discussionmentioning

confidence: 99%

Emphysematous Cholecystitis a Rare and Serious Clinical Entity: A Case Report of 6 Patients

Bi Kalou Ismaèl,

Inza,

Amos Serge

et al. 2023

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Introduction: Emphysematous cholecystitis or pneumocholecystitis is a condition caused by gas-forming microorganisms that cause ischemia and necrosis of the vesicular wall. It is characterized by the presence of gas in the wall and lumen of the gallbladder. Its incidence is higher in diabetics. It is a rare disease entity responsible for high mortality. However, early diagnosis combined with prompt and appropriate treatment can prevent the progression to septic shock and then death. The objective of this study was to describe the diagnostic and prognostic aspects, in order to enrich the limited literature concerning this pathology. Patients and methods: This was a descriptive retrospective study that ran from January 2019 to December 2021. It concerned patients admitted for emphysematous cholecystitis. Results: We collected 6 records of patients admitted for 6 emphysematous cholecystitis. They accounted for 1.8% of all cholecystectomies (n=278) and 4% of emergency cholecystectomies (n=112). These were 4 men (67%) and 2 women (33%). The mean age was 76.4 years. Patients generally had several histories, including the hypertension-diabetes couple, but 1 patient did not have diabetes. The average consultation time was 3 days. The clinical picture was acute generalized peritonitis in 1 patient and localized irritation to the right hypochondrium in 5 patients with septic shock. The diagnosis in all patients was made by abdominal CT scan. One patient had an ASA IV score, the other 5 patients had a score from ASA to III. In all cases, after intense resuscitation, cholecystectomy was performed, of which four (67%) were performed laparoscopically and 2 (33%) were performed by laparotomy. Bacteriology of bile fluid revealed gram-negative baccilia (E. coli, Citrobacter koseri) and gram-positive cocci (staphylococcus aerus) in 5 cases and 1 case of sterile fluid. The mean length of hospital stay was 5 days (range: 5-18 days). The morbidity was a case of parietal suppuration treated with local dressing. No deaths. Conclusion: Rare pathology. Diagnosis is essentially based on imaging, in this case abdominal CT scans. The prognosis depends on early and appropriate medical-surgical management.

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Section: Discussionmentioning

confidence: 99%

Emphysematous Cholecystitis a Rare and Serious Clinical Entity: A Case Report of 6 Patients

Bi Kalou Ismaèl,

Inza,

Amos Serge

et al. 2023

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“…The CT scan can also reveal pre-cholecystic inflammatory changes. Early diagnosis and treatment are essential, since if left untreated, EC can progress to soft tissue gangrene and lead to sepsis and death [ 9 ]. In this case, the additional finding of a CAP requested a prompt treatment strategy to avoid the risk of further complications in the case of acute rupture.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic treatment of an unruptured cystic artery pseudo-aneurysm in the presence of calculous emphysematous cholecystitis

Kelly

Shah

Motizada

et al. 2022

Journal of Surgical Case Reports

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Cystic artery pseudoaneurysm is a rare complication of invasive biliary procedures or of acute or chronic cholecystitis and pancreatitis. Emphysematous cholecystitis is an acute inflammatory process of the gallbladder due to gas forming organisms such as Escherichia coli and Clostridium perfringens. We report the case of a 34-year-old gentleman admitted with a 3-day history of generalized abdominal pain, vomiting and markedly raised inflammatory markers. A computed tomography scan demonstrated acute calculus cholecystitis and an incidental CAP. This was successfully treated with an emergency laparoscopic cholecystectomy. CAPs are reported in the literature as rare and are usually diagnosed after rupture with severe haemorrhage. In this report, we highlight that a non-ruptured CAP identified preoperatively can be safely managed simultaneously with a laparoscopic approach, thus avoiding the need for invasive angiographic procedures or open surgery.

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“…MRI can differentiate EC from adenomyomatosis and provide detail regarding intraluminal gas and intramural necrosis. 11,32 The appearance of gas in the gallbladder lumen and wall is that of signal void areas. 33 More specifically, intraluminal gas comprises various floating signal void bubbles in the upper dependent portion of the gallbladder lumen and/or extrahepatic bile duct.…”

Section: Sonographic and Other Imaging Findingsmentioning

confidence: 99%

“…2,31 A supine, erect, or decubitus radiograph of the abdomen will demonstrate one or more round bubbles or a pear-shaped lucency in the right upper quadrant (Figure 6). 32 Abdominal radiography can depict a gaseous halo around the gallbladder and gas-fluid level in the gallbladder, both of which are suspicious findings indicating the diagnosis of EC. 31 Magnetic resonance imaging (MRI) also is accurate in the diagnosis of EC.…”

Section: Sonographic and Other Imaging Findingsmentioning

confidence: 99%

Emphysematous Cholecystitis

Safwan

Penny

2016

Journal of Diagnostic Medical Sonography

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Emphysematous cholecystitis (EC) is a rare but deadly variant of acute cholecystitis noted by the presence of gas in the gallbladder lumen or wall. This gas, emitted by bacteria, is thought to result from gallbladder ischemia caused by vascular compromise with subsequent bacterial invasion. The two most common bacteria responsible for EC are Clostridia perfringens and Escherichia coli. Symptoms of EC are similar, although often less overt, compared to those of acute cholecystitis (AC). Sonography and radiography are common methods of diagnosing EC, but computed tomography (CT) carries the highest diagnostic accuracy rate. Laparoscopic cholecystectomy is the most common method of treating EC, although conservative therapy and hyperbaric oxygen therapy have also been effective in some cases.

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A Rare Case of Emphysematous Cholecystitis

Cited by 5 publications

References 9 publications

Emphysematous Cholecystitis a Rare and Serious Clinical Entity: A Case Report of 6 Patients

Emphysematous Cholecystitis a Rare and Serious Clinical Entity: A Case Report of 6 Patients

Laparoscopic treatment of an unruptured cystic artery pseudo-aneurysm in the presence of calculous emphysematous cholecystitis

Emphysematous Cholecystitis

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