Abstract
A 64-year-old man was admitted to the hospital because of epigastric pain. On admission, the WBC was 11,390/μl, CRP was 5.85mg/dl, and an abdominal CT scan disclosed a slightly distended gallbladder with a slightly thickened wall. Neither stones nor emphysematous changes were seen. Acute cholecystitis was diagnosed and conservative therapy was started. The pain increased gradually, and another abdominal CT scan taken on the next day revealed gas formation in the gallbladder and the pericholecystic tissue. Thus emphysematous cholecystitis was diagnosed and laparoscopic cholecystectomy was attempted on the same day. The laparoscopic cholecystectomy was converted to open surgery due to firm adhesions. The post-operative course was uneventful and the patient was discharged on the 13th hospital day.
Emphysematous cholecystitis requires prompt treatment, because severe complications such as necrosis and perforation can occur in a high frequency. However, it takes over 24 hours before air in the gallbladder can be detected, so that the diagnosis in an early stage is very difficult. If the symptoms suggestive of cholecystitis persist, repeated abdominal CT scanning must be done for making early diagnosis and treatment. It is considered that we have to perform laparoscopic cholecystectomy actively and to convert to open surgery without hesitation if firm adhesions resist it.
