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Gallbladder Pathology Online

Pathology of Emphysematous Cholecystitis

Dr Sampurna Roy  MD


Syn: Clostridial Cholecystitis.

Emphysematous cholecystitis is a serious variant of acute cholecystitis, characterized by the presence of gas in the gallbladder lumen, wall or pericholecystic tissues in the absence of any abnormal communication between the biliary system and the gastrointestinal tract. 


Gas-forming bacteria is present in the biliary system and the surrounding  tissues.

The pathogenesis of emphysematous cholecystitis is assumed to be ischemia.

Emphysematous cholecystitis is associated with diabetes mellitus and arteriosclerosis.

The disease predominantly affects elderly males usually over 50 years of age.

It has a higher mortality rate and a more rapid progression than acute cholecystitis, but has initial clinical findings, similar to those in acute cholecystitis patients.

Gas may be found within the wall of the gall bladder when secondarily infected by Clostridium perfringens, Escherichia coli, species of the genera Staphylococcus, Streptococcus,Pseudomonas and klebsiella species. 

Colonies of microorganisms may be demonstrated on a gram stain within the necrotic mucosa and within intramural abscesses.

Gas in the biliary ducts (pneumobilia) is rarely considered a manifestation of emphysematous cholecystitis.

Computed tomography  is extremely valuable in the assessment of suspected complications of acute cholecystitis, particularly emphysematous cholecystitis, hemorrhagic cholecystitis, and gallbladder perforation, which are often very difficult diagnoses to establish at sonography.

Reliable findings considering clinical status, ultrasonographic and radiological differential diagnosis, adequate and quick preoperative preparation, cholecystectomy and drainage with appropriate antibiotic treatment and hyperbaric oxygenation, represent the basic principles in diagnostics and treatment of this disease.

Visit: Infectious Disease Online ; Clostridial myonecrosis ; Klebsiella pneumoniae


Further reading:

Emphysematous cholecystitis successfully treated by laparoscopic surgery.

Emphysematous cholecystitis: Imaging findings.

[A case of emphysematous cholecystitis during the course of chemotherapy for gastric cancer].

[Emphysematous cholecystitis].

Case of emphysematous cholecystitis in a patient with type 2 diabetes mellitus associated with schizophrenia.

[Emphysematous cholecystitis].

Gas-containing gallstones as a cause of the "effervescent gallbladder" sign and pneumobilia.

[The acute emphysematous cholecystitis].

Emphysematous cholecystitis complicating liver abscess due to Clostridium baratii infection.

Emphysematous cholecystitis.

Emphysematous cholecystitis: Imaging findings in nine patients.

A comparative appraisal of emphysematous cholecystitis

Emphysematous cholecystitis in a patient with gastrointestinal stromal tumor treated with sunitinib.

Emphysematous cholecystitis due to Salmonella derby.

A comparative appraisal of emphysematous cholecystitis.

A case of gas-containing liver abscess associated with emphysematous change in the gallbladder

Emphysematous cholecystitis: diagnostic problems and differential diagnosis of gall bladder gas accumulations  

Gas in the bile ducts (pneumobilia) in emphysematous cholecystitis

Emphysematous cholecystitis: complication of hepatic artery embolization

Emphysematous cholecystitis: an insidious variant of acute cholecystitis

A case of anaerobic emphysematous cholecystitis with a subhepatic abscess

The changing face of emphysematous cholecystitis.

Emphysematous pyelonephritis with resultant emphysematous cholecystitis secondary to hematogenous dissemination










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