Abstract
A case of acute emphysematous cholecystitis is reported in which abdominal CT examination was useful for differential diagnosis.
A 49-year-old man with no eventful history was ademitted to the hospital because of epigastric pain. A plain film image showed an abnormal gas shadow within the wall of the gallbladder. Abdominal CT examination confirmed the air-fluid level in the lumen of the gallbladder. These findings suggested acute emphysematous cholecystitis. Cholecystectomy was immediately performed. The distended gallbladder showed gangrenous cholecysitis, and the cystic duct was found to be obstructed by a small calcium bilirubinate stone at operation. Culture of the intraoperative gallbladder bile was positive and Bacteroides spp. was found. Pathological examination of the resected gallbladder showed gangrenous cholecystitis and emphysema of the mucosa. By progressive diagnostic imaging of the abdomen, we were able to make an early diagnosis of this disease. This was valuable since early operation is the best choice of treatment.
