Emphysematous Cholecystitis: A Diagnostic Dilemma and Treatment Challenge
EAES Academy. Elnabil-Mortada A. 07/05/22; 363039; P083
Assoc. Prof. Ahmed Elnabil-Mortada
Contributions
Contributions
Abstract
Background:
Emphysematous cholecystitis (EC) is a rare life-threatening variant of acute cholecystitis. It is commonly seen in elderly men who are immunocompromised or have diabetes mellitus, or peripheral vascular disease. It is caused by gas-forming organisms such as Escherichia coli, Clostridium perfringens and Bacteroides fragilis and has a reported mortality of up to 25%. CT is the most sensitive diagnostic imaging study for the detection of intraluminal or intramural gallbladder gas.
Methods:
We report a diagnostic dilemma and multidisciplinary management of a case of emphysematous cholecystitis with unusual presentation in a healthy patient with no risk factors.
Results:
A 47-year-old male chef presented with a clinical picture of sepsis and abdominal pain. Initial investigations were normal apart from bilateral basal atelectasis, for which he was treated as pneumonia. He did not improve, with persistent fever and further investigations established the diagnosis of emphysematous cholecystitis. His clinical condition improved dramatically after urgent laparoscopic cholecystectomy on day 6. He was discharged on day 12 on completion of a course of IV antibiotics, with an uneventful postoperative recovery.
Conclusion:
A high index of clinical suspicion and multidisciplinary team management including surgery, radiology, and microbiology is crucial for early diagnosis of the rare life-threatening condition of emphysematous cholecystitis. EC is not limited to elderly morbid patients. Urgent laparoscopic cholecystectomy is the best treatment where feasible.
Emphysematous cholecystitis (EC) is a rare life-threatening variant of acute cholecystitis. It is commonly seen in elderly men who are immunocompromised or have diabetes mellitus, or peripheral vascular disease. It is caused by gas-forming organisms such as Escherichia coli, Clostridium perfringens and Bacteroides fragilis and has a reported mortality of up to 25%. CT is the most sensitive diagnostic imaging study for the detection of intraluminal or intramural gallbladder gas.
Methods:
We report a diagnostic dilemma and multidisciplinary management of a case of emphysematous cholecystitis with unusual presentation in a healthy patient with no risk factors.
Results:
A 47-year-old male chef presented with a clinical picture of sepsis and abdominal pain. Initial investigations were normal apart from bilateral basal atelectasis, for which he was treated as pneumonia. He did not improve, with persistent fever and further investigations established the diagnosis of emphysematous cholecystitis. His clinical condition improved dramatically after urgent laparoscopic cholecystectomy on day 6. He was discharged on day 12 on completion of a course of IV antibiotics, with an uneventful postoperative recovery.
Conclusion:
A high index of clinical suspicion and multidisciplinary team management including surgery, radiology, and microbiology is crucial for early diagnosis of the rare life-threatening condition of emphysematous cholecystitis. EC is not limited to elderly morbid patients. Urgent laparoscopic cholecystectomy is the best treatment where feasible.
Background:
Emphysematous cholecystitis (EC) is a rare life-threatening variant of acute cholecystitis. It is commonly seen in elderly men who are immunocompromised or have diabetes mellitus, or peripheral vascular disease. It is caused by gas-forming organisms such as Escherichia coli, Clostridium perfringens and Bacteroides fragilis and has a reported mortality of up to 25%. CT is the most sensitive diagnostic imaging study for the detection of intraluminal or intramural gallbladder gas.
Methods:
We report a diagnostic dilemma and multidisciplinary management of a case of emphysematous cholecystitis with unusual presentation in a healthy patient with no risk factors.
Results:
A 47-year-old male chef presented with a clinical picture of sepsis and abdominal pain. Initial investigations were normal apart from bilateral basal atelectasis, for which he was treated as pneumonia. He did not improve, with persistent fever and further investigations established the diagnosis of emphysematous cholecystitis. His clinical condition improved dramatically after urgent laparoscopic cholecystectomy on day 6. He was discharged on day 12 on completion of a course of IV antibiotics, with an uneventful postoperative recovery.
Conclusion:
A high index of clinical suspicion and multidisciplinary team management including surgery, radiology, and microbiology is crucial for early diagnosis of the rare life-threatening condition of emphysematous cholecystitis. EC is not limited to elderly morbid patients. Urgent laparoscopic cholecystectomy is the best treatment where feasible.
Emphysematous cholecystitis (EC) is a rare life-threatening variant of acute cholecystitis. It is commonly seen in elderly men who are immunocompromised or have diabetes mellitus, or peripheral vascular disease. It is caused by gas-forming organisms such as Escherichia coli, Clostridium perfringens and Bacteroides fragilis and has a reported mortality of up to 25%. CT is the most sensitive diagnostic imaging study for the detection of intraluminal or intramural gallbladder gas.
Methods:
We report a diagnostic dilemma and multidisciplinary management of a case of emphysematous cholecystitis with unusual presentation in a healthy patient with no risk factors.
Results:
A 47-year-old male chef presented with a clinical picture of sepsis and abdominal pain. Initial investigations were normal apart from bilateral basal atelectasis, for which he was treated as pneumonia. He did not improve, with persistent fever and further investigations established the diagnosis of emphysematous cholecystitis. His clinical condition improved dramatically after urgent laparoscopic cholecystectomy on day 6. He was discharged on day 12 on completion of a course of IV antibiotics, with an uneventful postoperative recovery.
Conclusion:
A high index of clinical suspicion and multidisciplinary team management including surgery, radiology, and microbiology is crucial for early diagnosis of the rare life-threatening condition of emphysematous cholecystitis. EC is not limited to elderly morbid patients. Urgent laparoscopic cholecystectomy is the best treatment where feasible.
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