Diagnosis Of Emphysematous Cholecystitis Research Articles

Diagnosis of emphysematous cholecystitis with bedside ultrasound in a septic elderly female with no source of infection.

Diagnosis of emphysematous cholecystitis with bedside ultrasound in a septic elderly female with no source of infection.

Sonographic Non-Visualization of the Gallbladder: A Pitfall in Diagnosis of Emphysematous Cholecystitis

Emphysematous cholecystitis is an uncommon complication of calculous cholecystitis due to secondary infection of gallbladder wall with gas-forming enteric organisms. It carries high morbidity and mortality to the patients and a rapid and early diagnosis is essential in patient’s clinical outcomes. Ultrasonography is usually the first and foremost test performed in cases of suspected biliary diseases. Herein, we describe a diagnostic pitfall of ultrasound in a patient with emphysematous cholecystitis – non-visualization of gallbladder, caused by reverberations from air in the gallbladder wall.

Early Sonographic Diagnosis of Emphysematous Cholecystitis Successfully Treated With Antibiotics

Emphysematous cholecystitis (EC) is an uncommon form of acute cholecystitis, caused by secondary infection of the gallbladder wall with gas-forming organisms. The mortality rate of EC is as high as 25% due to complications such as gangrene, gallbladder perforation, pericholecystic abscess, and bile peritonitis. Traditionally, prompt emergency surgical intervention with open cholecystectomy is recommended for EC treatment. This case study of EC was diagnosed at an early stage with sonography and computed tomography and successfully treated by antibiotic treatment alone without surgery. With characteristic findings on sonography such as echogenic reflectors with posterior shadowing, EC is an important entity for sonographers to be able to identify. In the future as imaging with sonography and CT affords earlier diagnosis of EC, antibiotic therapy might be considered for some patients, but more evidence is needed to obtain the same outcome as this particular case.

Gallbladder torsion-induced emphysematous cholecystitis in a 16-year-old boy

The patient was a 16-year-old boy who had turned to the right rapidly as he fielded a baseball that had come to him quickly. Two days after this event, which occurred in July 2004, he was admitted to hospital with repeated vomiting and increasing right hypochondralgia. Laboratory examination on admission showed elevation of the white blood count and of serum C-reactive protein and total bilirubin. Computed tomography on admission demonstrated an enlarged gallbladder and a thickened wall without gallstones, and magnetic resonance imaging performed 1 day later showed air within the gallbladder wall. His symptoms worsened, with a positive Murphy's sign, and emergency laparotomy was performed, with a diagnosis of emphysematous cholecystitis. Intraoperatively, the gallbladder was dark red, necrotic, distended, and enlarged. The cystic duct was attached only to the mesentery, and the gallbladder was floating freely, with the neck of the gallbladder having rotated 180 degrees counterclockwise, leading to a definitive diagnosis of gallbladder torsion with emphysematous cholecystitis. Cholecystectomy was performed, and analysis of bile showed Escherichia coli to be the causative organism. Histopathologic examination revealed necrotized cholecystitis. The patient is doing well 25 months after surgery, with an uneventful postoperative course.

Gallbladder aspirate from a dog

A 7-year-old, male, castrated, Labrador Retriever with a history of pancreatitis and inflammatory bowel disease presented for vomiting and anorexia. Serum biochemistry findings were indicative of cholestasis, hepatocellular insult, and decreased hepatic function. Ultrasound examination showed sediment and gas within the gallbladder, and a diagnosis of emphysematous cholecystitis was made. Emergency gallbladder resection was performed. Cytologic examination of bile fluid collected at surgery showed a mixed population of bacteria (bactibilia) together with fungal organisms consistent with Cyniclomyces guttulatus (previously known as Saccharomycopsis guttulatus). Similar fungal organisms were seen on a fecal smear. Bacteria cultured were normal gastrointestinal flora, supporting ascending infection; the fungal organisms were interpreted as incidental. Histopathology of the gallbladder indicated active (suppurative) and chronic (lymphocytic) cholecystitis and sections of liver tissue had evidence of chronic liver disease. A positive liver culture indicated concurrent bacterial hepatitis or cholangiohepatitis. Despite supportive care, the dog continued to decline and was euthanized 30 days later. Necropsy results confirmed end stage liver disease, but an initiating cause was not found. This case highlights the role of bactibilia in the development of acute cholecystitis and the unique cytologic appearance of C guttulatus as an incidental finding in bile fluid.

The changing face of emphysematous cholecystitis.

Emphysematous cholecystitis is a variant of acute cholecystitis characterized by the presence of gas in the gall bladder lumen, wall or pericholecystic tissues in the absence of an abnormal communication between the biliary system and the gastrointestinal tract. In the past, the diagnosis has relied on the plain abdominal radiograph (AXR), since there are no clinical features to separate this condition from simple acute cholecystitis. The apparently high mortality and morbidity associated with emphysematous cholecystitis has previously emphasized the importance of emergency cholecystectomy. We have reviewed eight cases of emphysematous cholecystitis presenting to this hospital over the last 5 years. The diagnosis was made on AXR in only one of these cases. Ultrasound (US) scans were performed in all eight cases, of which five were positive and three negative, due to non-visualization of the gall bladder. In the three negative cases, the diagnosis was made on subsequent CT scans. On initial clinical examination, only one of the eight patients appeared systemically unwell and conservative management was employed in five of the patients. The remaining three patients underwent cholecystectomy within 3-5 days because of continuing signs or symptoms. It is concluded that the AXR is relatively insensitive in the diagnosis of emphysematous cholecystitis. As a result of the regular use of US in suspected hepatobiliary disease, emphysematous cholecystitis is being diagnosed with increased frequency, uncovering a broad spectrum of disease ranging from mild to severe. Previously, failure to separate milder cases from simple acute cholecystitis may have been responsible for reports of unremitting severity and progression requiring emergency cholecystectomy. Based on clinical assessment, conservative surgical management is possible in a significant proportion of patients.

A CASE OF ACUTE EMPHYSEMATOUS CHOLECYSTITIS

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.

Emphysematous Cholecystitis

Emphysematous cholecystitis (EC) is a rare and dramatic disease that requires prompt therapeutic procedures. The authors report a case of a 70-year-old-woman, admitted to the Intensive Care Unit for Infectious Diseases of the Santa Maria Hospital, with the diagnosis of EC. The literature on EC is also reviewed.

The ultrasound diagnosis of emphysematous cholecystitis

Abstract Emphysematous cholecystitis is an uncommon illness which may be mimicked by acute cholecystitis but which carries a more serious prognosis. The pre-operative diagnosis is usually difficult to make but may be suggested by a plain abdominal radiograph. The ultrasound appearances are characteristic and are illustrated by two representative cases. Comparison is made with other causes of gall-bladder wall abnormality.

Diagnosis of emphysematous cholecystitis by computerized tomography

A case of emphysematous cholecystitis is presented in which computerized tomography helped to confirm the diagnosis and the extent of disease preoperatively. This unusual disorder is briefly reviewed and the clinical and radiographic findings are discussed.