| Fatal
emphysematous cholecystitis caused by clostridium perfringens.Surgery.
2007 Mar;141(3):411-2.
Emphysematous
cholecystitis.Clin
Gastroenterol Hepatol. 2007 Mar;5(3):e9. Epub 2007 Jan 31
Gallbladder
torsion-induced emphysematous cholecystitis in a 16-year-old boy.
J Hepatobiliary Pancreat Surg. 2007;14(6):608-10. Epub 2007 Nov
30.
The patient was a
16-year-old boy who had turned to the right rapidly as he fielded a
baseball that had come to him quickly. Two days after this event,
which occurred in July 2004, he was admitted to hospital with repeated
vomiting and increasing right hypochondralgia. Laboratory examination
on admission showed elevation of the white blood count and of serum
C-reactive protein and total bilirubin. Computed tomography on
admission demonstrated an enlarged gallbladder and a thickened wall
without gallstones, and magnetic resonance imaging performed 1 day
later showed air within the gallbladder wall. His symptoms worsened,
with a positive Murphy's sign, and emergency laparotomy was performed,
with a diagnosis of emphysematous cholecystitis. Intraoperatively, the
gallbladder was dark red, necrotic, distended, and enlarged. The
cystic duct was attached only to the mesentery, and the gallbladder
was floating freely, with the neck of the gallbladder having rotated
180 degrees counterclockwise, leading to a definitive diagnosis of
gallbladder torsion with emphysematous cholecystitis. Cholecystectomy
was performed, and analysis of bile showed Escherichia coli to be the
causative organism. Histopathologic examination revealed necrotized
cholecystitis. The patient is doing well 25 months after surgery, with
an uneventful postoperative course.
Emphysematous cholecystitis in a patient with gastrointestinal stromal
tumor treated with sunitinib.
Pharmacotherapy. 2007
May;27(5):775-7.
A 50-year-old man
had a metastatic gastrointestinal stromal tumor that was refractory to
imatinib. He was prescribed a 6-week course of treatment with oral
sunitinib 50 mg/day. During the fourth week of his first cycle of
treatment with the drug, the patient developed acute-onset, right
upper quadrant pain associated with nausea, vomiting, and fever;
laboratory tests revealed leukocytosis and mild hyperbilirubinemia. He
was diagnosed with acute emphysematous cholecystitis, which was
treated with broad-spectrum antibiotics and percutaneous
cholecystostomy. His symptoms resolved, and he successfully completed
his course of therapy with sunitinib. Using the Naranjo adverse drug
reaction probability scale, a score of 5 was derived, which indicates
that the likelihood was probable that this adverse event was caused by
sunitinib.
A patient with
acute abdominal pain and known cardiovascular disease. Tidsskr
Nor Laegeforen. 2007 Mar 15;127(6):736-7
BACKGROUND: Emphysematous
cholecystitis (EC) is a serious variant of acute cholecystitis (AC),
with gas-forming bacteria in the biliary system and the surrounding
tissues. The pathogenesis of EC is assumed to be ischemia. EC is
associated with diabetes mellitus and arteriosclerosis; has a higher
mortality rate and a more rapid progression than AC, but has initial
clinical findings, similar to those in AC-patients. METHOD: We present
a case report describing a patient with cardiovascular disease and
sepsis, who has acalcular emphysematous cholecystitis. The patient was
treated with antibiotics and percutaneus drainage. We performed a
PubMed search for "Cholecystitis, Emphysematous, Acalcular". The
literature study describes case reports and retrospective analyses.
INTERPRETATION: EC arises in 1-3% of AC, with a mortality rate of 15%,
compared to 4% in AC. EC has a 30-fold risk of necrosis and a 5-fold
risk of perforation of the gall bladder wall compared to AC.
Ultrasound imaging may be difficult to interpret and CT scanning is
the preferred method of diagnosis. Recommended treatment is immediate
cholecystectomy in association with antibiotics directed against the
most common infectors, Cl. perfringens and enteropathogenic bacteria.
Open and laparoscopic procedures seem equal in outcome. Some reports,
as the present, describe successful treatment with percutaneous
drainage when necrosis-mediated perforation is absent.
Emphysematous
cholecystitis. Review of five cases and report of septic
musculoskeletal complications.Chirurgia
(Bucur). 2006 Jan-Feb;101(1):61-4.
A variant of
acute cholecystitis is emphysematous cholecystitis. Here in we
reviewed useful clinical data of five cases of this entity. Clinical
outcomes were uncomplicated for three patients who were treated with
open cholecystectomy. But on the other hand we faced two septic
musculoskeletal complications in two patients who were treated with
percutaneous trans gallbladder drainage. We believe that we must be
aware of musculoskeletal complications, whenever a patient with
emphysematous cholecystitis is treated with percutaneous trans
gallbladder drainage.
Emphysematous
cholecystitis due to Salmonella derby.Lancet
Infect Dis. 2006 Feb;6(2):118-20.
We present the
case of a woman with diabetes mellitus who developed symptoms and
signs consistent with gastroenteritis. After admission for hydration,
the patient rapidly became critically ill and an abdominal catastrophe
was suspected as the cause of her deterioration. Computed tomography
of her abdomen was done and revealed gas in the lumen of the
gallbladder consistent with emphysematous cholecystitis. She underwent
emergent cholecystectomy, which revealed that the gallbladder had
already ruptured. Blood cultures grew Salmonella derby. After a
prolonged hospitalisation she eventually recovered and was discharged
home. Emphysematous cholecystitis, thought to be a variant of acute
cholecystitis, is a medical and surgical emergency. Diagnosis relies
heavily on imaging findings by ultrasound or computed tomography since
the clinical presentation is often non-specific. Cholecystectomy
remains the treatment of choice in addition to broad spectrum
antibiotics and other supportive measures.
A case of
emphysematous cholecystitis managed by laparoscopic surgery.JSLS.
2005 Oct-Dec;9(4):478-80.
BACKGROUND:
Emphysematous cholecystitis is a rare condition caused by ischemia of
the gallbladder wall with secondary gas-producing bacterial
proliferation. The pathophysiology and epidemiology of this condition
differ from that in gallstone-related acute cholecystitis. This report
illustrates a case of emphysematous cholecystitis successfully treated
by laparoscopic surgery. METHODS: An 83-year-old female patient was
admitted to the hospital with acute abdominal syndrome. Clinical
examination and blood tests suggested acute cholecystitis. Plain
radiography revealed a circular gas pattern in the right upper
quadrant suggestive of emphysematous cholecystitis. Subsequent
computed tomography confirmed the presence of gas in the gallbladder
wall and a gas-fluid level within the organ. RESULTS: Emergency
laparoscopic cholecystectomy was successfully performed during which
bubbling of the gallbladder wall was observed. Intraoperative
cholangiography revealed no bile duct stones or biliary obstruction.
The patient made an unremarkable recovery from surgery with no
postoperative complications or admission to the intensive care unit.
Pathological analysis revealed full-thickness infarctive necrosis of
the gallbladder. Bacterial cultures grew Clostridium perfringens.
CONCLUSIONS: This case illustrates a typical case of emphysematous
cholecystitis successfully treated by laparoscopic surgery. It
contributes to suggestions from other reports that this condition can
be safely treated by the laparoscopic approach.
Ultrasound and CT evaluation of emergent gallbladder pathology.Radiol
Clin North Am. 2003 Nov;41(6):1203-16
Ultrasound is the
initial imaging modality of choice for the evaluation of suspected
acute gallbladder disorders, and is often sufficient for correct
diagnosis. CT also plays a vital role, however, in the evaluation of
acute gallbladder pathology. CT is particularly useful in situations
where ultrasound findings are equivocal. CT is also 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. If CT is the initial imaging test
performed in a patient with abdominal pain of uncertain etiology,
recognition of the various disorders described in this article may
eliminate the need for further imaging and facilitate appropriate
management.
Emphysematous cholecystitis.
Med Pregl. 2002 Nov-Dec;55(11-12):529-31.
INTRODUCTION:
Emphysematous cholecystitis is a rare gallbladder pathology
characterized by gas accumulation in the gallbladder wall as a result
of severe inflammation, mostly caused by bacteria known as Clostridium
species. CASE REPORT: This is a case report of a 59 year-old male
diabetic, with typical anamnestic, clinical, ultrasonographic and
radiological findings, pointing to acute cholecystitis of
emphysematous form. Surgical and bacteriological procedures confirmed
the preoperative findings. CONCLUSION: 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.
Acute emphysematous cholecystitis preceded by symptoms of ileus:
report of a case.Surg
Today. 2002;32(2):183-5.
We herein
describe a case of acute emphysematous cholecystitis in which the
patient presented with symptoms of ileus. The patient was a
72-year-old man with no history of diabetes mellitus. He presented
with epigastric pain, vomiting, and low-grade fever. Plain abdominal
radiography showed some intestinal gas and niveau, and he was admitted
to our hospital with a diagnosis of ileus. The next day, the abdominal
pain increased and was accompanied by muscular defense. Plain
radiography and computed tomography of the abdomen were carried out,
and an emergency laparotomy was performed under a diagnosis of
panperitonitis due to a perforation of the gallbladder caused by acute
emphysematous cholecystitis. The patient made favorable progress after
the operation and was discharged on postoperative day 14. Percutaneous
transhepatic gallbladder drainage has been increasingly performed for
the treatment of acute emphysematous cholecystitis. but when a
perforation of the gallbladder is suspected, a laparotomy first should
be considered.
Emphysematous cholecystitis: sonographic findings.Abdom
Imaging. 2002 Mar-Apr;27(2):191-5.
BACKGROUND:
Emphysematous cholecystitis (EC) is a rare but life-threatening
complication of acute cholecystitis, and an early diagnosis is
required to prevent delay in patient management. Because sonography
(US) is the first choice for diagnosing gallbladder diseases, US
findings of EC should be understood more precisely. METHODS: We
reviewed US findings of 11 surgically proven cases of EC (with small
amounts of gas in three cases and large amounts in eight cases) and
compared those with patients' clinical data. RESULTS: (1) In cases
with small amounts of gas, US showed an echogenic line with a distinct
ring-down artifact or a "powder snow-like" speckled posterior echo.
(2) In cases with large amounts of gas, US showed a wide spiculated
echogenic band with a powder snow-like speckled posterior echo or a
speckled acoustic shadowing. In all cases, the presence of gas
prevented visualization of the gallbladder wall. (3) US did not
differentiate gas localized to the gallbladder wall and gas extending
to the surrounding hepatic tissue. (4) Two diabetic cases showed gas
throughout the intrahepatic bile ducts. In those cases, the time from
diagnosis to recovery was relatively long. CONCLUSION: Our series
showed some characteristic US patterns of EC. A good understanding of
its US findings and appropriate emergent management will reduce the
serious morbidity and mortality rates caused by EC.
Acute emphysematous cholecystitis. Report of twenty cases.
Hepatogastroenterology. 1999 Jul-Aug;46(28):2144-8.
BACKGROUND/AIMS:
Our aim is to present our experience with acute emphysematous
cholecystitis (AEC), a severe variety of acute cholecystitis
characterized by early gangrene and perforation of the gallbladder.
METHODOLOGY: We reviewed the clinical records of 20 patients with AEC,
analyzing age, sex, past medical history, symptoms, laboratory tests,
X-rays, ultrasounds, operative and microbiological findings, morbidity
and mortality. RESULTS: Our study included 13 men and 7 women (mean
age 59 years). Associated factors were diabetes mellitus (11 cases)
and gallstones (6 cases, 3 of them with common bile duct stones).
Clinical symptom presentation included: right hypochondrial pain and
fever in all cases, vomiting in 9, septic shock in 3, jaundice in 7,
and peritonitis in 8. Hyperbilirubinemia was present in 7 cases. Plain
abdominal X-rays or ultrasounds led to diagnosis in 95% of the cases.
Surgical findings were AEC in all cases, pericholecystic abscess in 8,
gallbladder necrosis in 7 and bile peritonitis in 3. C perfringens, E
coli and B fragilis were the most frequent pathogens. Mortality rate
was 25%, and morbidity 50%. CONCLUSIONS: AEC predominantly affects
elderly diabetic men. Abdominal X-rays or ultrasounds are good
diagnostic techniques, and emergency surgery is needed due to the high
incidence of gangrene and perforation Despite all the efforts made,
morbidity and mortality are still high.
The
changing face of emphysematous cholecystitis.Br
J Radiol. 1997 Oct;70(838):986-91.
Emphysematous
cholecystitis is a variant of acute cholecystitis characterized by the
presence of gas in the gall bladder lumen, wall or pericholecystic
tissues in the absence of an abnormal communication between the
biliary system and the gastrointestinal tract. In the past, the
diagnosis has relied on the plain abdominal radiograph (AXR), since
there are no clinical features to separate this condition from simple
acute cholecystitis. The apparently high mortality and morbidity
associated with emphysematous cholecystitis has previously emphasized
the importance of emergency cholecystectomy. We have reviewed eight
cases of emphysematous cholecystitis presenting to this hospital over
the last 5 years. The diagnosis was made on AXR in only one of these
cases. Ultrasound (US) scans were performed in all eight cases, of
which five were positive and three negative, due to non-visualization
of the gall bladder. In the three negative cases, the diagnosis was
made on subsequent CT scans. On initial clinical examination, only one
of the eight patients appeared systemically unwell and conservative
management was employed in five of the patients. The remaining three
patients underwent cholecystectomy within 3-5 days because of
continuing signs or symptoms. It is concluded that the AXR is
relatively insensitive in the diagnosis of emphysematous cholecystitis.
As a result of the regular use of US in suspected hepatobiliary
disease, emphysematous cholecystitis is being diagnosed with increased
frequency, uncovering a broad spectrum of disease ranging from mild to
severe. Previously, failure to separate milder cases from simple acute
cholecystitis may have been responsible for reports of unremitting
severity and progression requiring emergency cholecystectomy. Based on
clinical assessment, conservative surgical management is possible in a
significant proportion of patients.
Emphysematous pyelonephritis with resultant emphysematous
cholecystitis secondary to hematogenous dissemination.
Abdom Imaging. 1995 Mar-Apr;20(2):169-72.
Both
emphysematous pyelonephritis and emphysematous cholecystitis are
uncommon, but potentially fatal, clinical entities. The simultaneous
diagnosis of these two entities in the same patient has not previously
been reported. In this paper, we describe a 68-year-old diabetic male
who presented acutely with emphysematous pyelonephritis and
emphysematous cholecystitis. This case demonstrates several important
diagnostic and treatment considerations. Additionally, the unique
circumstances of this case offer support for the proposal that
emphysematous cholecystitis may often be secondary to hematogenous
seeding/embolic phenomena rather than obstruction of the cystic duct.
Prompt diagnosis is essential, as prompt intervention can minimize
mortality and morbidity.
A
case of gas-containing liver abscess associated with emphysematous
change in the gallbladder.Hiroshima
J Med Sci. 1995 Mar;44(1):7-11.
We describe a
77-year-old man with diabetes mellitus who developed a large
gas-containing pyogenic liver abscess after admission. Mild elevation
of serum biliary enzyme levels suggested probable biliary trouble on
admission. Ultrasonography and computed tomography showed a large
abscess of the liver with gas formation and the presence of gas within
the lumina of the gallbladder and biliary tract when the patient had
fever, leukocytosis and evidence of hepato-renal dysfunction. These
findings suggest that the large liver abscess may have developed as a
result of emphysematous cholecystitis.
A
comparative appraisal of emphysematous cholecystitis.
Am J Surg. 1975 Jan;129(1):10-5.
There is ample
evidence from this retrospective comparison to indicate that
emphysematous cholecystitis does merit clinical distinction apart from
acute cholecystitis. It is an acute infection of the gallbladder
caused by a specific group of bacteria that may be aided by some
aspect of local ischemia. Cholelithiasis does not seem to be a major
factor in the pathogenesis of emphysematous cholecystitis, and this,
in association with some dependence upon ischemia, may account for the
predominance of this disease in males rather than females. Gangrene is
a common feature of the pathologic process, and thus it is not
surprising that the diagnosis of emphysematous cholecystitis implies a
risk of gallbladder perforation that is five times that expected from
ordinary acute cholecystitis. The key to identifying this disease is
the plain abdominal roentgenogram which in most instances will make
the diagnosis and provide an impetus for early operative intervention.
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