Emphysematous cholecystitis presenting as gas-forming liver abscess and pneumoperitoneum in a dialysis patient: a case report and review of the literature

Abstract

BackgroundEmphysematous cholecystitis is a rare variant of acute cholecystitis with a high mortality rate. The combination of emphysematous cholecystitis, liver abscess and pneumoperitoneum are even rarer. Herein we present a case of emphysematous cholecystitis in a senile diabetic lady who had worsening hemodynamics while undergoing hemodialysis.Case presentationA 64-year-old woman with history of type 2 diabetes mellitus and end stage renal disease with regular hemodialysis presented to the emergency department with a 1-day history of sudden onset of lassitude and hypotension during hemodialysis. The result of a computed tomography (CT)-scan revealed air encircling the gallbladder, liver parenchymal and minimal pneumoperitoneal and liver abscess with no cholelithiasis. The patient had received empirical antibiotics with piperacillin-tazobactam 2.25 g intravenous route every 6 h for 14 days and cholecystectomy with surgical debridement and lead an uneventful postoperative hospital course. Escherichia coli was demonstrated as well as blood culture and peritoneal fluid culture.ConclusionIn a senile diabetic and dialysis patient, we should take emphysematous cholecystitis into consideration once vague abdominal pain occurrs. Empirical antibiotic therapy and adequate surgical intervention should take place as soon as possible.

Post-ERCP Emphysematous Cholecystitis in a Young Woman: A Rare and Potentially Fatal Complication

“…Ultrasound is not a reliable modality to exclude emphysematous cholecystitis as evidenced by a report of Clostridium perfringens related emphysematous cholecystitis: ultrasound imaging of the gallbladder showed gallbladder wall thickening consistent with acute cholecystitis but CT imaging 2 hours later confirmed an emphysematous cholecystitis with perforation and pneumoperitoneum [2]. Plain X-ray imaging has detected radiological signs of EC [10, 11], but the sensitivity is very low.…”

Emphysematous cholecystitis in a young male without predisposing factors

“…[ 14 ] The symptoms of EC are almost identical with those of acute cholecystitis, right upper quadrant pain, fever, vomiting, and jaundice, but EC begins as acute cholecystitis, then develops into ischemia and gangrene in the gallbladder wall with gas encircling the gallbladder due to gas-forming organisms, including E coli, Clostridium welchii , Perfringens, Klebsiella , and Streptococci . [ 1 , 3 , 7 , 15 , 16 ] Hence, gas encircling the gallbladder or air within the gallbladder becomes the typical presentation of EC from the CT-scan. [ 3 , 14 ] Of courses, ultrasonography (USG) and plain radiography can also be used for the diagnosis of EC.…”

“…[ 1 , 3 , 7 , 15 , 16 ] Hence, gas encircling the gallbladder or air within the gallbladder becomes the typical presentation of EC from the CT-scan. [ 3 , 14 ] Of courses, ultrasonography (USG) and plain radiography can also be used for the diagnosis of EC. However, USG, which almost depends on the number of air pockets and on localization in the soft tissues, is an operator-dependent and less sensitive technique, [ 12 , 17 ] whereas a gaseous halo around the gallbladder and gas-fluid level in the gallbladder can be shown more clearly by plain radiography and CT-scan.…”

“…Imaging showing gas in gallbladder walls or lumen is the most important and accurate clinical characteristic for diagnosing of EC. [ 3 ] There is no doubt that the postoperative pathological analysis of resected gallbladder is the gold standard, yet it cannot provide us any indications before the operation. There are few literatures reported (Table 1 ); therefore, we decided to share our experience in the diagnosis and treatment of EC.…”

Progress in clinical research complicated infection with diabetes mellitus

“…For treatment, early acute cholecystectomy is necessary due to the rapid progression of the disease quality. Broad-spectrum antibiotics that cover anaerobic bacteria and intestinal Gram-positive and Gram-negative pathogens should be used as early as possible [21][22].…”