A Case of Acute Emphysematous Cholecystitis with Rapid Changes in the Clinical and Imaging Findings

Abstract

There are few case reports of mild acute cholecystitis progressing to acute emphysematous cholecystitis, with rapid changes in the clinical and imaging findings. We present a case of mild acute cholecystitis that progressed to acute emphysematous cholecystitis, with rapid exacerbation of the clinical and imaging findings.

An 82-year-old man was admitted to our hospital complaining of right hypochondrial pain of sudden onset. Physical examination revealed tenderness in the right hypochondrium. Based on the findings of abdominal CT and hematological examinations, we made the diagnosis of mild acute cholecystitis. From the CCI and ASA class, early laparoscopic cholecystectomy was judged as being associated with some risk, and the patient was started on antibiotic treatment. While the abdominal symptoms improved with this treatment, on the 3rd day of hospitalization, the patient developed high fever (38.0°C) and worsening of the right hypochondrial pain. Blood examination revealed increased levels of inflammatory response markers. DIC-CT showed acute emphysematous cholecystitis with localized peritonitis. Emergent PTGBD was performed because he had already taken aspirin on the day and had poorly controlled DM. After the abdominal and inflammatory findings improved, subtotal cholecystectomy was performed due to the presence of severe abdominal inflammatory findings on the 10th day after PTGBD. The patient was discharged 14 days after the operation after an uneventful postoperative course. It is important to keep in mind that even cases of mild cholecystitis can progress to severe acute emphysematous cholecystitis, with rapid changes in the clinical and imaging findings.