A case of emphysematous cholecystitis associating with gas in the bile duct and showing a rapid imaging change

Abstract

A 73-year-old man was admitted to the hospital because of epigastric pain with nausea and vomiting. At admission imaging diagnostic methods disclosed a swollen gallbladder with the thickened wall, but there were no emphysematous changes and acute cholecystitis was diagnosed. Conservative therapy with administration of SBT/CPZ at a dose of 1g/day was started, but no clinical remission was attained and remarkable elevations in CRP and CPK were noted. For that another abdominal CT scan was performed about 27 hours after the initial scanning that showed low density areas in the circumference of the gallbladder and intrahepatic bile duct. Thus emphysematous cholecystitis was diagnosed and laparotomic cholecystectomy was performed on the same day. The removed gallbladder was diagnosed as acute gangrenous cholecystitis. A culture of the bile juice yielded C. perfringens, E. casseliflavus, and E. coli which were considered causative microorganisms.
This paper presents our experience with emphysematous cholecystitis which was associated with gas in the bile duct and showed a rapid imaging change, together with some bibliographical comments.