RESUMEN
La colecistitis enfisematosa es una rara forma de presentación de la colecistitis aguda. Es causada por isquemia vascular y se caracteriza por la presencia de gas en la pared, en la luz o en ambas, la cual puede evolucionar a un cuadro de extrema urgencia asociada a una alta tasa de morbilidad y mortalidad. Se presenta un caso de un paciente con un cuadro de dolor abdominal con síntomas gastrointestinales y signos de respuesta inflamatoria sistémica con diagnóstico presuntivo de colecistitis enfisematosa que se realizó una colecistectomía laparoscopia de urgencia, con una adecuada evolución postoperatoria
Emphysematous cholecystitis is an uncommon variant of acute cholecystitis. It is caused by a vascular ischemia and characterized by the presence of gas in the wall, in the lumen, or in both. It can evolve into a life-threatening condition associated with a high rate of morbidity and mortality. We present a case of a patient who presented with abdominal pain, gastrointestinal symptoms, and signs of a systemic inflammatory response with a presumptive diagnosis of emphysematous cholecystitis. An emergency laparoscopic cholecystectomy was performed, with an adequate postoperative evolution
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Laparoscopía , Colecistitis Enfisematosa/cirugía , Colecistitis Enfisematosa/patología , Diagnóstico Precoz , Urgencias MédicasRESUMEN
Antecedentes: la colecistitis enfisematosa (CE) es una forma de presentación infrecuente de la colecistitis aguda. Material y métodos: presentecedentes patológicos, mientras que los otros eran diabéticos. A todos se les realizó tomografía computarizada (TC). Dos pacientes fueron sometidos a colecistectomía videolaparoscópica (CL) con buena evolución, mientras que en un caso se realizó colecistostomía percutánea (CP). Discusión: la CE se refiere a la presencia de gas en la luz o en la pared de la vesícula biliar. La tasa de morbilidad es del 50%. Los pacientes suelen padecer diabetes, pero puede presentarse en pacientes más jóvenes sin factores de riesgo. La TC es el método de elección para el diagnóstico. El tratamiento definitivo es la CL, aunque la CP es otra opción válida. Conclusión: la CL se considera un enfoque eficaz y seguro para el tratamiento de la CE.
Background: Emphysematous cholecystitis (EC) is a rare presentation of acute cholecystitis. Material and methods: We report three cases of EC in two men and one woman between 55 and 79 years. One of the patients was otherwise healthy while the other two were diabetics. A computed tomography (CT) scan was performed in all the cases. Two patients underwent video-assisted laparoscopic cholecystectomy with favorable outcome and one patient underwent percutaneous cholecystostomy. Discussion: Emphysematous cholecystitis is characterized by the presence of gas in the gallbladder lumen or wall. Mortality rate is 50%. Most patients are diabetics, but EC may present in younger patients without risk factors. Computed tomography scan is the method of choice for the diagnosis. Cholecystectomy is indicated as definite treatment, but percutaneous cholecystostomy may be a valid option. Conclusions: Laparoscopic cholecystectomy and antibiotics are effective and safe to treat.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Colecistectomía Laparoscópica/métodos , Colecistitis Enfisematosa/cirugía , Colecistostomía/métodos , Tomografía Computarizada por Rayos X/métodos , Dolor Abdominal/complicaciones , Colecistitis Enfisematosa/tratamiento farmacológico , Colecistitis Enfisematosa/diagnóstico por imagen , Complicaciones de la Diabetes , Abdomen/diagnóstico por imagen , Hipertensión/complicacionesRESUMEN
La colecistitis enfisematosa es una rara forma de presentación de la colecistitis aguda, caracterizada por la presencia de gas en la pared, en la luz o ambas, la cual puede evolucionar a colecistitis gangrenosa y posteriormente a peritonitis. Se asocia con una alta tasa de morbilidad y mortalidad. Se presentan tres casos clínicos de hombres adultos mayores, que presentaron dolor abdominal con síntomas gastrointestinales y signos de respuesta inflamatoria sistémica. Se les practicó tomografía computadorizada de abdomen, que evidenció hallazgos característicos de colecistitis enfisematosa. Los tres pacientes se sometieron a colecistectomía de urgencia, con una adecuada evolución posoperatoria y sin complicaciones mayores ni mortalidad.
Emphysematous cholecystitis is a rare presentation of acute cholecystitis, characterized by the presence of intramural or intraluminal gas; it can evolve to gangrenous cholecystitis and peritonitis, and is associated with high morbidity and mortality rates. Three clinical cases, all elderly men, are reported, who presented abdominal pain with gastrointestinal symptoms and signs of systematic inflammatory response. CT of abdomen showed the characteristic findings of emphysematous cholecystitis. The three patients underwent emergency cholecystectomy, and all had adequate postoperative evolution without complications or mortality.
Asunto(s)
Colecistitis Enfisematosa , Terapéutica , Colecistectomía Laparoscópica , DiagnósticoRESUMEN
Background. Emphysematous pyelonephritis is a necrotizing infection characterized by gas production that usually is located in the kidney tissue, urinary tract and retroperitoneal tissue. Gas can escape following the renal veins and accumulate in the hepatic veins and other places. E coli is the most common causative organism. Clinical case: We report a 62 years old diabetic female, admitted to the hospital with a diabetic ketoacidosis. An abdominal CT scan disclosed a left emphysematous pyelonephritis, cholecystitis and cystitis. The patient was operated, performing a left nephrectomy, cholecystectomy and placement of sub hepatic and retroperitoneal drainages. The pathological study of the surgical piece showed an acute pyelonephritis with abscess formation and chronic cholecystitis. The patient died due to a multi systemic failure.
Introducción: La Pielonefritis enfisematosa es una infección necrotizante caracterizada por la producción de gas, que habitualmente se ubica en el parénquima renal, las vías urinarias y los tejidos retroperi-toneales. Cuando el gas es abundante puede escapar siguiendo las venas renales y acumularse en las venas hepáticas, y el resto del sistema. La E. coli es el patógeno más frecuente. Caso clínico: Presentamos el caso de paciente femenina de 62 años, diabética que ingresa con sintomatología de vías urinarias diagnosticada como pielonefritis enfisematosa izquierda por tomografía y encontrando como hallazgos adicionales.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Cistitis , Colecistitis Enfisematosa , /complicaciones , Pielonefritis , Cistitis/cirugía , Cistitis/complicaciones , Colecistitis Enfisematosa/cirugía , Colecistitis Enfisematosa/complicaciones , Cetoacidosis Diabética , Enfisema/complicaciones , Resultado Fatal , Insuficiencia Multiorgánica , Pielonefritis/cirugía , Pielonefritis/complicaciones , Tomografía Computarizada por Rayos XRESUMEN
Transarterial chemoembolization (TACE) is reportedly a useful palliative treatment in patients with unresectable or recurred hepatocellular carcinoma. Post-TACE complications are common; however, acute cholecystitis after TACE is rare. We herein report a case of a 73-year-old woman who presented with emphysematous cholecystitis and pneumobilia following TACE. Computed tomography performed for evaluation of her tumor status before TACE incidentally showed gallbladder and common bile duct stones. After TACE, she complained of severe epigastric pain with a positive Murphy's sign. Computed tomography showed emphysematous cholecystitis and pneumobilia. She was successfully treated with emergent biliary stone removal by endoscopic retrograde cholangiopancreatography.
Asunto(s)
Anciano , Femenino , Humanos , Carcinoma Hepatocelular , Quimioembolización Terapéutica , Colangiopancreatografia Retrógrada Endoscópica , Colecistitis Aguda , Conducto Colédoco , Colecistitis Enfisematosa , Vesícula Biliar , Cuidados PaliativosRESUMEN
The Mercedes-Benz Sign can be observed on both plain abdominal radiography and abdominal computed tomography as well. This radiological sign is formed by the presence of gas within gallstones, with a typical triradiate arrangement, and it may be indicative of biliary calculi. It was first seen in 1931 on plain radiographs performed on patients with unexplained abdominal pain and it was subsequently observed on computed tomography scans, an imaging procedure being increasingly used as the method of choice for the study of patients with abdominal complaints. Although the Mercedes-Benz sign is suggestive of gallstones in most cases, differential diagnoses such as emphysematous cholecystitis and gas in the biliary tract have to be performed.
El signo del Mercedes Benz se observa tanto en radiografía simple de abdomen como en to-mografía computada y está dado por la presencia de gas que se dispone en forma de estrella de tres puntas dentro de cálculos biliares, luego de un proceso de cristalización natural de los mismos. Fue descrito en 1931 en radiografías simples realizadas a pacientes con dolor abdominal sin causa aparente y luego se lo observó en tomografía computada, método cada vez más utilizado para el estudio de pacientes de este tipo. Si bien el signo del Mercedes Benz permite presumir la presencia de cálculos biliares en la mayoría de los casos, también deben considerarse diagnósticos diferenciales como aerobilia y colecistitis enfisematosa.
Asunto(s)
Humanos , Colelitiasis , Gases , Colecistitis Enfisematosa , Cálculos Biliares , Diagnóstico DiferencialRESUMEN
La colecistitis enfisematosa es un raro proceso infeccioso que se caracteriza por la presencia de gas en la vesícula biliar, asociado frecuentemente con gérmenes anaerobios. Se presenta el caso de una paciente femenina de 58 años de edad que ingresó por guardia con un cuadro de dolor abdominal en epigastrio irradiado al dorso. El diagnóstico se basa en su presunción clínica; en los casos dudosos una ecografía o una tomografía computada pueden confirmarlo. La administración de antibióticos de amplio espectro y la colecistectomía de urgencia constituyen el tratamiento adecuado para la resolución de esta patología.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Colecistitis Enfisematosa/diagnóstico , Colecistitis Enfisematosa/terapia , Colecistitis Enfisematosa , Colecistitis/diagnóstico , UltrasonografíaRESUMEN
Emphysematous infections of the abdomen and pelvis are potentially life-threatening conditions which require aggressive medical and surgical management. Therefore, early radiographic detection is important in the management of these conditions. Concurrent emphysematous infections involving different organs have been rarely reported, and primarily occur in immunocompromised patients. Here, we report a rare case of concurrent emphysematous cholecystitis and emphysematous pancreatitis in a 97 year old male patient.
Asunto(s)
Humanos , Masculino , Abdomen , Colecistitis Enfisematosa , Huésped Inmunocomprometido , Pancreatitis , Pelvis , Tomografía Computarizada por Rayos XRESUMEN
Emphysematous cholecystitis is an uncommon but life-threatening form of acute cholecystitis that is caused by gas- forming organisms such as Clostridia species, Escherichia coli, Klebsiella, and anaerobic streptococci. Emphysematous cholecystitis frequently affects elderly men, and is associated with diabetes mellitus. The risk of gangrene and perforation of the gallbladder is relatively high in emphysematous cholecystitis patients, and there is a 15% mortality compared with the 4% for acute cholecystitis. We report here a case of emphysematous cholecystitis in a 56-year-old woman, who had diabetes for 10 months. The patient presented with right upper abdominal pain and chills. The abdominal plain film showed a mottled gas pattern in the right upper quadrant. The laboratory value revealed massive intravascular hemolysis. The patient deteriorated rapidly during the course of the evaluation and required cardiopulmonary resuscitation. Despite the attempts to resuscitate the patient, she died 9 hours after the onset of symptoms.
Asunto(s)
Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor Abdominal , Reanimación Cardiopulmonar , Escalofríos , Colecistitis Aguda , Diabetes Mellitus , Colecistitis Enfisematosa , Escherichia coli , Vesícula Biliar , Gangrena , Hemólisis , Klebsiella , Mortalidad , SepsisRESUMEN
No abstract available.
Asunto(s)
Anciano , Humanos , Masculino , Colecistografía , Colecistitis Enfisematosa/diagnósticoRESUMEN
Emphysematous cholecystitis is an uncommon form of acute cholecystitis characterized by the presence of gas within the wall, lumen of the gall bladder or biliary ducts. Clinically it is very similar to ordinary farm. But since the risk of perforation is five times that expected from ordinary cholecystitis, early diagnosis and appropriate surgical treatment are important. We could diagnose these cases by the simple abdomen, abdominal ultrasound and abdominal CT by the presence of air in the lumen and the wall of the gall bladder. Percutaneous trans hepatic gall bladder drainage (PTGBD) for decompression was used because poor general condition of patients and later, we could successfully perform the cholecystectomy without any complication. We presented two cases of emphysematous cholecystitis with review of the relevant literature on the subject.
Asunto(s)
Humanos , Abdomen , Colecistectomía , Colecistitis , Colecistitis Aguda , Descompresión , Drenaje , Diagnóstico Precoz , Colecistitis Enfisematosa , Tomografía Computarizada por Rayos X , Ultrasonografía , Vejiga UrinariaRESUMEN
There has not been any report on massive air-containing liver abscess in diabetic patients, although emphysematous cholecystitis or pyelonephritis is a well-known complication in them. Authors report two cases of emphysematous liver abscess in diabetic patient, which showed typical findings of massive air-containing hepatic abscess on ultrasonography and computed tomography, but very poor progrosis in spite of immediate and successful percutanoeus drainage procedure.
Asunto(s)
Humanos , Drenaje , Colecistitis Enfisematosa , Absceso Hepático , Hígado , Pielonefritis , UltrasonografíaRESUMEN
Emphysematous cholecystitis is an uncommon condition which may mimic acute cholecystitis. But it differs from acute cholecystitis in its relatively greater frequency in men and diabetics and has graver prognosis. The condition is diagnosed by demonstration of air in lumen,wall of gallbladder and/or pericholecystic space using a variety of radiographic techniques: simple abdominal radiography, ultrasonography and CT scanning. One illustrative case is presented herein and the pertinent literature is reviewed.