Acute Emphysematous Cholecystitis

Comments:
Acute Emphysematous Cholecystitis: It is a rare form acute cholecystitis caused by infection with gas-producing bacteria. Clostridium welchii/perfringens, E. coli, Klebsiella species, Bacteriodes fragilis, and anaerobic streptococci have been implicated. Patients are often elderly with comorbidities such as diabetes and atherosclerotic heart disease. It is a surgical emergency due to high risk of gangrene and perforation of gallbladder. Mortality is 15-20%. Computed tomography (CT) scan is the most sensitive diagnostic test.

This abdominal CT without contrast is from an elderly male who presented with diffuse abdominal pain. It shows intramural and intraluminal gas collections in the gallbladder. Foci of gas are also seen near the medial gallbladder wall and scattered through peritoneum. CT findings are compatible with emphysematous cholecystitis with gallbladder perforation and pneumoperitoneum.

Case courtesy of Nerses Nersesyan, Radiopaedia.org. From the case rID: 47798