Emphysematous Calculous Cholecystitis Diagnosed with Abdominal CT in a Diabetic Female Patient - Case Report.

Emphysematous cholecystitis is reported to have a low incidence of less than 1% in all cases of acute cholecystitis and yet a high mortality rate of up to 15%. It is most commonly seen in male diabetic patients with advanced age. The diagnosis is established with the presence of gas in the gallbladder lumen and/or within its wall which can be seen on plain abdominal radiography, abdominal ultrasound, and abdominal computerized tomography. The clinical presentation refers to one of acute cholecystitis, but the treatment requires prompt cholecystectomy since the patient's condition can deteriorate due to the possibility of gallbladder perforation. We present a case of a 71-year-old female diabetic patient with calculous emphysematous cholecystitis treated with emergency open cholecystectomy.

Acute emphysematous cholecystitis due to clostridium perfringens: a rare entity requiring aggressive and early treatment.

Acute emphysematous cholecystitis is a rare entity (1% of acute cholecystitis) characterized by the presence of gas in the gallbladder lumen, gallbladder wall or even in the bile duct (pneumobilia). It is associated with arteriosclerosis, embolic events, and diabetes mellitus and as in other similar pathologies such as emphysematous gastritis or emphysematous pancreatitis the most frequently isolated microorganisms are Streptococcus pyogenes, Escherichia coli and Staphylococcus aureus, although others such as Proteus vulgaris, Pseudomonas aeruginosa, Clostridium perfringens and Klebsiella pneumoniae have also been found.

Colecistitis enfisematosa: Manejo satisfactorio por vía laparoscópica / Emphysematour cholecystitis: satisfactory outcome by laparoscopically managment

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

A Rare Ultrasonographic Finding of Emphysematous Cholecystitis: The Champagne Sign.

BACKGROUND: Emphysematous cholecystitis (EC) is a form of cholecystitis with high mortality rates more commonly seen in patients with medical histories such as diabetes, hypertension, and peripheral vascular disease. The common features of these medical diseases are impaired pain perception, particularly abdominal pain, due to advanced age and peripheral neuropathies. Accurate evaluation of characteristics observed at ultrasonography, the method of first choice in the diagnosis of EC, is therefore highly important in these patients. CASE REPORT: This study reports a case of the champagne sign, rarely seen in EC, together with other EC findings. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The champagne sign is a little-known sonographic finding that is evidence of the presence of gas in the gallbladder. The champagne sign that will be detected while evaluating the hepatobiliary system on bedside ultrasound is one of the valuable findings in the diagnosis of emphysematous cholecystitis with high mortality.

Respuesta a «Colecistitis enfisematosa en un paciente con sospecha de infección por SARS-CoV-2» / Response to «Emphysematous cholecystitis in suspected SARS-CoV-2 infection»

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Gas Where It Shouldn't Be! Imaging Spectrum of Emphysematous Infections in the Abdomen and Pelvis.

OBJECTIVE. The purpose of this article is to review the spectrum, etiopathogenesis, clinical presentation, imaging features, differential diagnoses, and management of emphysematous infections of the abdomen and pelvis. CONCLUSION. Emphysematous infections are associated with high morbidity and mortality and thus need urgent medical and surgical interventions. CT is the most sensitive modality to detect gas; CT provides definitive diagnosis in most cases and can depict the extent of involvement.

Septic shock with emphysematous cholecystitis and disseminated infection caused by hypervirulent Klebsiella pneumoniae capsular genotype K2-ST65 in a Japanese man with diabetes mellitus: A case report.

Hypervirulent Klebsiella pneumoniae capsular genotypes K1 and K2 are common pathogens responsible for community-acquired liver abscesses and invasive infections especially in East Asia. We report a Japanese man with diabetes mellitus who rapidly developed emphysematous cholecystitis and fulminant disseminated infection with life-threatening multiple organ-system failure due to K. pneumoniae K2 strains belonging to sequence type 65. In East Asia, clinicians should be aware of fulminant infections caused by hypervirulent K2 strains in patients with community-acquired K. pneumoniae infections. Further epidemiological studies are warranted to elucidate the clinical features associated with the virulence K. pneumoniae K2 strains.

Emphysematous cholecystitis: A rare complication / Colecistitis enfisematosa: una complicación rara

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Colecistitis enfisematosa: presentación de tres casos / Emphysematous cholecystitis: a report of three cases

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.

Utility of leucocytes, inflammatory markers and pancreatic enzymes as indicators of gangrenous cholecystitis.

BACKGROUND: Acute cholecystitis is an emergency condition. If not promptly diagnosed and properly managed, the complication of gangrenous cholecystitis may develop, which may be a life-threatening complication. OBJECTIVES: The study aims to examine various characteristics and physiological parameters in patients diagnosed with acute cholecystitis to evaluate if significant predictive factors exist for the differential diagnosis of gangrenous cholecystitis. MATERIALS AND METHODS: This was a retrospective study included patients with acute cholecystitis diagnosis, who presented to 'blinded for peer review' from 1 January 2010 to 1 January 2017. Parameters evaluated included liver function tests, complete cell count, C reactive protein, erythrocyte sedimentation rate (ESR), amylase and lipase levels, as well as medical history, and presenting clinical signs. Cases were divided according to whether or not there was a histopathological diagnosis of gangrenous cholecystitis. RESULTS: A total of 186 (54.5%) female and 155 (45.5%) male cases were examined. Patients with gangrenous cholecystitis tended to be male, showed a significantly higher white cell count, higher neutrophil percentage, lower lymphocyte percentage and higher ESR compared with patients without gangrenous cholecystitis. However, serum amylase and lipase demonstrated no differential diagnostic utility CONCLUSION: Male patients with a high ESR level, high total leucocyte count with a relative high proportion of neutrophils and a low proportion of lymphocytes were found to be at increased risk of the presence of gangrenous cholecystitis.

Large liver abscess and cholecystogastric fistula / Secondary to emphysematous cholecystitis

BACKGROUND: Emphysematous cholecystitis is a rare variant of acute cholecystitis. The association of emphysematous cholecystitis with a liver abscess is rare, and its association with cholecystogastric fistula is exceptional.Case Presentation. An 81-year-old woman with a long history of 2-type diabetes and systemic arterial hypertension presented to the emergency department with a 12-day course of antibiotic treatment for liver abscess and emphysematous cholecystitis without receiving surgical treatment. CT scan showed a large liver abscess in segment IV b and V, gallbladder with wall thickening. Surgical treatment was performed, finding large hepatic abscess and cholecystogastric fistula secondary to emphysematous cholecystitis. E. coli was obtained in the culture, and the findings were confirmed in the histopathological report. CONCLUSION: The cholecystogastric fistula with a large hepatic abscess in a patient with emphysematous cholecystitis is exceptional

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