ABSTRACT
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.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Cholecystectomy, Laparoscopic/methods , Emphysematous Cholecystitis/surgery , Cholecystostomy/methods , Tomography, X-Ray Computed/methods , Abdominal Pain/complications , Emphysematous Cholecystitis/drug therapy , Emphysematous Cholecystitis/diagnostic imaging , Diabetes Complications , Abdomen/diagnostic imaging , Hypertension/complicationsSubject(s)
Emphysematous Cholecystitis/surgery , Abdominal Abscess/surgery , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Cholecystostomy , Clostridium perfringens , Emphysematous Cholecystitis/diagnostic imaging , Emphysematous Cholecystitis/drug therapy , Enterococcus faecium , Female , Gallbladder Diseases/surgery , Gas Gangrene/diagnosis , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/drug therapy , Humans , Rupture, Spontaneous , Tomography, X-Ray ComputedABSTRACT
Emphysematous cholecystitis and emphysematous cystitis occurring concurrently has not been reported before. This article discusses a non-diabetic patient suffering from both these conditions concurrently with Escherichia coli as the causative organism - a first in the medical literature.
Subject(s)
Cystitis , Emphysema , Emphysematous Cholecystitis , Escherichia coli Infections , Aged, 80 and over , Anti-Infective Agents/therapeutic use , Cefuroxime/therapeutic use , Cystitis/diagnostic imaging , Cystitis/drug therapy , Cystitis/microbiology , Drug Therapy, Combination , Emphysema/diagnostic imaging , Emphysema/drug therapy , Emphysema/microbiology , Emphysematous Cholecystitis/diagnostic imaging , Emphysematous Cholecystitis/drug therapy , Emphysematous Cholecystitis/microbiology , Escherichia coli Infections/complications , Escherichia coli Infections/diagnostic imaging , Escherichia coli Infections/drug therapy , Humans , Male , Metronidazole/therapeutic use , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Emphysematous Cholecystitis/diagnostic imaging , Tomography, X-Ray Computed , Aged , Anti-Bacterial Agents/therapeutic use , Cholecystectomy , Combined Modality Therapy , Emphysematous Cholecystitis/drug therapy , Emphysematous Cholecystitis/microbiology , Emphysematous Cholecystitis/surgery , Humans , MaleSubject(s)
Cholecystography , Emphysematous Cholecystitis/diagnostic imaging , Tomography, X-Ray Computed , Abdominal Pain/etiology , Aged , Anti-Bacterial Agents/therapeutic use , Cerebral Infarction , Diabetes Mellitus, Type 1/epidemiology , Emphysematous Cholecystitis/diagnosis , Emphysematous Cholecystitis/drug therapy , Emphysematous Cholecystitis/epidemiology , Gallbladder/diagnostic imaging , Humans , Male , Postoperative Complications , UltrasonographyABSTRACT
We present the case of a woman with diabetes mellitus who developed symptoms and signs consistent with gastroenteritis. After admission for hydration, the patient rapidly became critically ill and an abdominal catastrophe was suspected as the cause of her deterioration. Computed tomography of her abdomen was done and revealed gas in the lumen of the gallbladder consistent with emphysematous cholecystitis. She underwent emergent cholecystectomy, which revealed that the gallbladder had already ruptured. Blood cultures grew Salmonella derby. After a prolonged hospitalisation she eventually recovered and was discharged home. Emphysematous cholecystitis, thought to be a variant of acute cholecystitis, is a medical and surgical emergency. Diagnosis relies heavily on imaging findings by ultrasound or computed tomography since the clinical presentation is often non-specific. Cholecystectomy remains the treatment of choice in addition to broad spectrum antibiotics and other supportive measures.
