Abstract
We report the case of an 89-year-old woman with emphysematous cholecystitis and acute obstructive suppurative cholangitis, and portal venous gas. The woman visited the hospital with the chief complaint of high fever, and was admitted for further examination and treatment. Abdominal CT showed bile duct stones, and proximal bile duct dilatation, and gas in the gallbladder wall and intrahepatic portal vein. We made the diagnosis of emphysematous cholecystitis and acute obstructive suppurative cholangitis with bile duct stones, and portal venous gas. There were several serious challenges in the treatment. Gas in the gallbladder wall meant that ultrasonography could not show the gallbladder or be used for drainage guidance. Percutaneous transhepatic gallbladder drainage was therefore avoided. Instead, we selected endoscopic retrograde cholangiopancreatography with endoscopic nasobiliary drainage. The general condition of the patient improved, and cholecystectomy was performed the following day.
