Computed tomography as the method of choice in the diagnosis of emphysematous cholecystitis

Perforated Emphysematous Cholecystitis: A Race Against Time

Emphysematous cholecystitis is a rare infection of the gallbladder that stems from acute cholecystitis. It can rapidly progress and perforate the gallbladder, which would require urgent surgical intervention. A perforated gallbladder can be diagnosed using an abdominal computed tomography by confirming the presence of air in the gallbladder lumen with adjacent extraluminal air. The causes of ruptured emphysematous cholecystitis include, but are not limited to, diabetes, atherosclerotic changes in blood vessels, and infection with Clostridium perfringens, Escherichia coli, and Klebsiella spp., and is usually present in diabetic men. We report on a 57-year-old female who developed gall bladder perforation with an overflow of gallstones into the peritoneum without a history of diabetes or atherosclerotic disease. Due to the vast availability of computerized tomography and early surgical intervention, the rate of mortality due to perforated emphysematous cholecystitis has decreased over the last few decades.

Emphysematous cholecystitis due to Clostridium perfringens successfully treated by cholecystectomy

Emphysematous Cholecystitis is life threatening if left untreated. It is associated with arteriosclerosis, embolic events, and diabetes mellitus. In this report, a patient was presented with an early diagnosis of Emphysematous Cholecystitis and was treated by cholecystectomy without complications. A 46-year-old male presented at the emergency department. Laboratory results as well as the abdominal ultrasound showed no abnormalities. One day after admission, infection parameters started rising. A computed tomography (CT) showed cholecystitis with a circular gas pattern in bile ducts and gallbladder. After treatment with cholecystectomy and antibiotics, the patient recovered uneventfully. The gallbladder mucosa was denaturized with signs of necrosis. The bile culture was positive for Clostridium perfringens. Treatment was based on preoperative antibiotic treatment combined with cholecystectomy. This resulted in early clinical improvement of the patient and normalization of infection parameters. Therefore, the patient was discharged from the hospital four days postoperatively.

[Emphysematous cholecystitis: a pathologic entity. A case report]

Emphysematous cholecystitis is a rare but real entity, which have to be recognized early in order to quickly start the best treatment. We report a case of acute emphysematous cholecystitis diagnosed with computed tomography. A successful outcome was obtained by antibiotherapy and cholecystectomy in emergency.

Acute cholecystitis: CT findings

Some patients with acute cholecystitis may have symptoms suggestive of an abscess or other intra-abdominal inflammation and, therefore, may be referred for a CT of the abdomen. This report reviews the pathophysiology, clinical presentation, and CT findings of acute cholecystitis (gallstones, wall thickening, distention, pericholecystic fluid, and pericholecystic stranding). Pitfalls and complications of the diagnosis are discussed. Those scenarios where CT may prove superior to ultrasound or hepatobiliary scintigraphy are highlighted.

Subcutaneous emphysema of the lower extremity of abdominal origin

Three cases of subcutaneous emphysema of the lower extremity due to abdominal disease are reported. These were due to (a) perforation of the sigmoid, (b) perirectal abscess, and (c) non-traumatic metastatic gas gangrene due to emphysematous cholecystitis. The mechanisms and anatomical pathways are discussed.

Efficacy of plain abdominal radiography in patients with biliary tract disease

A retrospective review was performed to determine the usefulness of plain abdominal radiographs in patients presenting to the emergency department with gallbladder disease. Patients with the clinical diagnosis of biliary tract disease were divided into two groups: those with confirmed biliary tract disease and those who did not have gall bladder disease. There were no major radiologic findings (pneumoperitoneum, pneumobilia, or bowel obstruction) in any patient with biliary tract disease. No significant difference was noted in the incidence of minor radiologic findings (right upper quadrant calcification, mild ileus and right basilar atelectasis) in patients with biliary colic and acute cholecystitis. Additionally, there was no significant difference in minor findings between patients with biliary tract and nonbiliary tract disease. Plain abdominal radiographic findings were found to be nonspecific in patients with gallbladder disease and not useful in differentiating between patients with biliary colic and acute cholecystitis. Our results also suggest that plain abdominal radiographic findings are not useful in differentiating between patients with and without biliary tract disease, although the selection of patients without biliary tract disease may have biased this finding.