Acute Emphysematous Cholecystitis

Comments:
Acute Emphysematous Cholecystitis: This laparoscopic cholecystectomy specimen is from a 75 y/o female who presented with diffuse abdominal pain, malaise and generalized body aches. Imaging studies were suggestive of emphysematous cholecystitis with perforation.

During surgery, intra-abdominal examination showed gangrenous gallbladder with adhesions to the duodenum and omentum. The gallbladder was perforated and frank pus was coming out from the gallbladder. Approximately 600 ml thick pus was aspirated from the gallbladder. Multiple pigmented stones were also seen in the gallbladder.

The gallbladder measured 13 cm in length, 9 cm in circumference and 0.8 cm in thickness. There was transmural necrosis with many perforations throughout the gallbladder wall. The external surface was irregular and brownish. Mucosa was diffusely ulcerated & covered with exudates.

Case courtesy of Ammar Ashraf, Radiopaedia.org. From the case rID: 85579; image background changed and used under Creative Commons license.