2019 Volume 39 Issue 4 Pages 703-706
A 87-year-old woman visited our hospital complaining of abdominal pain with onset a week previously. She had rebound tenderness and defense in the right upper quadrant of the abdomen. Laboratory data showed elevation of inflammation markers. Abdominal CT showed air bubbles in a swollen gallbladder, intraabdominal free air, pneumobilia and gallstones. She was admitted with a diagnosis of perforated emphysematous cholecystitis and generalized peritonitis，and underwent an emergency operation. During the operation, gallbladder perforation, bile leakage and gallstones in the abdominal cavity were found. We performed a subtotal cholecystectomy. Bilious ascites culture showed the inflammation had been caused by Escherichia coli. Pathological examination of the gallbladder revealed gangrenous cholecystitis. Surgical site infection occurred in day 6 which was treated with antibiotics, otherwise the postoperative course was uneventful. There have been 13 cases of cholecystitis with intraabdominal free air reported in Japan.
