2021 Volume 35 Issue 2 Pages 182-187
The patient was a 96-year-old man who had undergone endoscopic sphincterotomy (EST) for choledocholithiasis two years ago; the presence of gas was observed in the bile duct (pneumobilia) and the gallbladder.
The presence of acalculous emphysematous cholecystitis prompted an emergency surgery. Although no gallbladder perforation was observed, an intraoperative specimen collected by gallbladder puncturing revealed E. coli and Bacteroides fragilis. Since the patient was suffering from acalculous cholecystitis, we considered that the inflammation of the gall bladder wall was caused by ischemia and led to infection. Due to this, we could not identify inflammatory responses at the time of onset. This may have resulted in an exacerbation of the wall inflammation and marked necrosis, leading to an increase in gallbladder pressure that may have caused the leakage of gases and fluids into the abdominal cavity.
This disease is characterized by acute cholecystitis. Clinicians should suspect the presence of the disease in everyday clinical practice. This study is the first to report a case of emphysematous cholecystitis with preoperative pneumobilia. Although establishing the diagnosis was challenging, the patient's life was saved.
