Current experience with emphysematous cholecystitis

Abstract

Background: Emphysematous cholecystitis (EC) is a rare variant of acute cholecystitis with a reported 15-25% mortality rate. Conventionally, EC is managed with an early open cholecystectomy. However, recent advancement in percutaneous intervention and laparoscopic techniques have influenced our management of this biliary pathology. This study reviews the management and outcomes of EC in a regional centre.Methods: Retrospective analysis of a clinical database constituting all patients diagnosed with EC at a regional Australian hospital in NSW from Jan 2010 to July 2019. Inclusion criteria: sepsis, abdominal pain and radiological evidence of gas in the gallbladder wall, lumen, and pericholecystic tissue in the absence of an abnormal connection between the gallbladder and gastrointestinal tract. We investigated patient risk factors, management and outcomes.Results: 16 patients with EC were identified. The mean age of the cohort was 73 years old. The majority of patients had co-morbidity including type 2 diabetes and ischemic heart disease (56 and 62% respectively). Laparoscopic cholecystectomies were performed in 9 patients during their index admissions and 7 patients were managed with PTC. 5 patients required ICU admission for septic shock, and all were managed with PTC drain placement. The overall mortality rate was 6%.Conclusions: Laparoscopic cholecystectomy on index admission is the treatment of choice for EC. Although more technically challenging, adverse clinical event including major complication and open conversion was avoided in our cohort while percutaneous cholecystostomy was reserved for unstable and poor surgical candidate.