Abstract
We experienced a case of acute enphysematous cholecystitis associating with air in the bile duct in a 76-year-old man who had no stones, mud, and sand in the gallbladder and bile duct. The patient was seen at the hospital because of right hypochondralgia with muscle defense. Blood examination indicated remarkably inflammatory response and impaired liver function. Abdominal imagings showed air in the gallbladder and bile duct. The patient was diagnosed as acute emphysematous cholecystitis and emphysematous cholangitis. On the day of admission emergency laparotomy was carried out when the gallbladder wall was dark brown in color, indicating gangrenous cholangitis. With cultivation of bile juice collected during the operation, a Clostridium was detected. There were no underlying diseases such as hypertension, diabetes, and ischemic heart disease in this patient. The mechanisms of the onset of the disease may involve tissue necrosis due to ischemia in the gallbladder wall and consequent infection caused by aerogenous anarobe. It is thought that air in the bile duct in this case may result from inflow of air in the gallbladder through the cystic duct. Since the main pathology of emphysematous cholecystitis lies on gangrenous cholecystitis, this disease appears to demand some surgical treatment as soon as possible.
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