A case of emphysematous cholecystitis with cholecystic arterial thromboses and gallbladder infarction

Abstract

We report a case of emphysematous cholecystitis (EC). An 82-year-old woman was hospitalized for subarachnoidal hemorrhage. She presented with fever, vomiting, hypotension, and slight abdominal tenderness in the right upper quadrant. Abdominal computed tomography (CT) revealed the air-fluid level in the lumen of the gallbladder and gas around the wall. The patient underwent cholecystectomy. Laparotomy revealed necrotic changes in the gallbladder. A bile culture revealed Clostridium species infection. The histopathological findings were multiple arterial thromboses and gallbladder infarction. The pathogenesis of EC is controversial, but many cases of emphysematous cholecystitis were acalculous and have been reported in individuals with a history of diabetes mellitus, hypertension, cerebrovasucular accidents, or ischemic heart disease. We consider that the case presented here proves the hypothesis that ischemia and necrotic changes may occur in the gallbladder due to a primary vascular compromise, and that gas-producing bacteria grow under anaerobic conditions, resulting in the development of EC.