Diagnosis: Emphysematous cholecystitis. Patient with diabetes, relatively minimal right upper quadrant pain, but with signs of sepsis presenting to the emergency room ultimately diagnosed with emphysematous cholecystitis.
Clinical Presentation:
- Emphysematous cholecystitis is a rare but potentially life-threatening complication of acute cholecystitis, characterized by gas-forming bacteria in the gallbladder wall and lumen.
- Patients with emphysematous cholecystitis may present with symptoms such as abdominal pain, fever, nausea, and vomiting.
- In severe cases, patients may develop signs of sepsis, including hypotension and altered mental status.
Findings on Imaging:
- Imaging studies such as abdominal x-ray, ultrasound, or CT may show evidence of gas within the gallbladder lumen and wall, which is the hallmark of emphysematous cholecystitis.
- In some cases, imaging may also reveal evidence of gallstones or gallbladder distension.
Next Steps in Management:
- Management of emphysematous cholecystitis involves emergent surgical intervention to remove the infected gallbladder and prevent further complications.
- Antibiotic therapy is also necessary to treat the underlying infection.
- In some cases, the patient’s condition may be too unstable for immediate surgery, in which case supportive measures such as fluid resuscitation and hemodynamic monitoring may be necessary.
Key Take Away Points:
- Emphysematous cholecystitis is a rare but potentially life-threatening complication of acute cholecystitis, characterized by gas-forming bacteria in the gallbladder wall and lumen.
- Imaging studies such as abdominal x-ray, ultrasound, or CT can help diagnose emphysematous cholecystitis by showing evidence of gas within the gallbladder lumen and wall.
- Emphysematous cholecystitis is an uncommon type of acute cholecystitis. The gallbladder wall breaks down due to necrosis resulting in foci of gas formation in the lumen and wall. Emphysematous cholecystitis is a surgical emergency. It is a surgical emergency, due to the high risk of mortality from gallbladder perforation. Look for the presence of a pneumoperitoneum as this may indicate perforation.
- Management of emphysematous cholecystitis typically involves emergent surgical intervention and antibiotic therapy to treat the underlying infection.
Submitted by Dr. Saeed Rad MD to radRounds Radiology Network
