A CASE OF ACUTE EMPHYSEMATOUS CHOLECYSTITIS

Abstract

Acute emphysematous cholecystitis is characterized by a specific gas image on plain abdominal X-ray films and detection of gas-producing organisms. This disease is a specific type of acute cholecystitis and shows a more serious course than other types. This paper describes a successfully treated case of acute emphysematous cholecystitis by surgical operation. A 55-year-old man was seen at the hospital because of right hypochondralgia. The WBC count was 13, 500/mm3, and CRP was 34.8mg/dl, suggesting marked inflammation. Plain abdominal X-ray examination showed a gas image corresponding to the outline of the gallbladder. Abdominal CT showed gas formation, with a mirror image appearance, in the swollen gallbladder. Based on these findings, a diagnosis of emphysematous cholecystitis was made, and operation was performed. The gallbladder was gangrenous, and abscesses were observed below the right diaphragm, around the gallbladder, and in the lesser omentum. Pathological examination showed necrosis of the gallbladder wall involving all layers, marked inflammatory cell infiltration, and many submucosal vacuoles that probably contained gas. Bile culture demonstrated Clostridium. It is thought that the pathologic characteristic of this disease lies in gangrenous cholecystitis, where surgical treatment in an early stage is necessary, if the general condition of the patient permits it.