A Case of Acute Emphysematous Cholecystitis with Intraperitoneal Free Air

Abstract

This report presents a case of an 88-year-old woman who developed emphysematous cholecystitis with intraperitoneal free air. She was diagnosed with gastrointestinal perforation because air-fluid level was not seen in the gallbladder lumen. However, operative findings revealed acute acalculous gangrenous cholecystitis. CT revealed air bubbles in the gallbladder wall, which was presumed to extend into the pericholecystic space, resulting in the intraperitoneal free air.
There have been only 5 case reports of emphysematous cholecystitis without air-fluid level in the gallbladder lumen in the Japanese literature over the past 15 years. Primary physicians should thus be aware of the fact that emphysematous cholecystitis without air-fluid level in the gallbladder could be a cause of acute abdomen with intraperitoneal free air.