Abstract
A 62-year-old woman who had been medicated for hypertension was admitted to our hospital with a chief complaint of epigastralgia. Plain abdominal X-ray showed air-fluid levels in the right hypochondriac region surrounded by abnormal gas and free air under the right diaphragm. Abdominal CT showed air-fluid levels in a swollen gallbladder and gas in the thickened wall of the gallbladder, in the common bile duct and under the abdominal wall. Under a diagnosis of gastrointestinal perforation and emphysematous cholecystitis, emergency operation was performed with laparoscopy. We did not find gastrointestinal perforation but rather found the gallbladder to be dark purple and swollen. When we punctured it with the trocar, gas escaped. Cholecystectomy was performed under laparotomy because of gallbladder weakness. Pathologic examination of the gallbladder revealed gangrenous cholecystitis, and Clostridial organisms in the wall by Gram stain. There have been no reports of emphysematous cholecystitis with intraabdominal free air in Japan.
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