A Case of Gangrenous Cholecystitis with Extraluminal Air Confined to the Pelvic Cavity

Abstract

A 90-year-old female patient was transported to our hospital with a history of consciousness disorder. Abdominal CT showed acute cholecystitis, intraabdominal free air confined to the pelvic cavity, mesenteric emphysema, air around the uterus and ovaries, and retroperitoneal emphysema. Emergency laparotomy was carried out under the diagnosis of lower gastrointestinal perforation. Intraoperative examination showed necrotic changes of the gallbladder, but no perforation of the intestine. We performed cholecystectomy. After the surgery, the patient developed septic shock and disseminated intravascular coagulation, but could eventually be discharged from the hospital 36 days after the surgery. Clostridium perfringens, a gas-producing bacterium, was detected in cultures of bile fluid specimens collected intraoperatively. Postoperative histopathology revealed emphysematous changes in the walls of the gallbladder. There are only a few reported cases of emphysematous cholecystitis with extraluminal air confined to the pelvic cavity.