Cholecystitis (emphysematous)

Emphysematous cholecystitis is a rare condition in which bubbles of gas from anaerobic infection appear in the lumen of the gallbladder, its wall, the pericholecystic space, and sometimes the bile ducts.

• Clostridia species, especially C.welchii or Clostridia perfringens, are most often involved, but other gas forming anaerobes such as E. coli or anaerobic streptococci may be found (1).
• Men are affected three times more often than women and 40% of patients have diabetes mellitus (1).

The patient presents with sudden and rapidly progressive right upper quadrant pain, fever and leucocytosis.

• A palpable mass may be felt in the right upper quadrant.

Plain abdominal films reveal gas in the gallbladder lumen and wall and are highly characteristic.

• Rarely, a CT scan may be necessary.

The patient should immediately be given appropriate antibiotics followed by emergency surgery:

• cholecystectomy is preferred
• if the patient is too ill, cholecystostomy may be performed

Reference:

1. Miyahara H, Shida D, Matsunaga H, Takahama Y, Miyamoto S. Emphysematous cholecystitis with massive gas in the abdominal cavity. World J Gastroenterol. 2013 Jan 28;19(4):604-6. doi: 10.3748/wjg.v19.i4.604. PMID: 23382645; PMCID: PMC3558590.