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PubMed1999

[Emphysematous cholecystitis. Diagnosis, clinical course, and treatment].

Emphysematous cholecystitis is the most severe acute cholecystitis with infection by gas-producing organism. The morbidity and mortality rate are 15%. We present a retrospective study of emphysematous cholecystitis seen in our department during three years (1992-1994). Inclusion criteria were made on the basis of a characteristic history, physical examination and radiology findings. Eight patients were studied. All were men, medium age 75 years (range: 45-88). None of them was diabetic. Clinical history was typical for the disease. Radiological examinations included abdominal X-ray (none of them was demonstrative), abdominal ultrasound (carry out in five patients and diagnosis in two) and computerised tomography scanning was necessary in the others three patients. Surgery was required since complication occurred in two patients. The mean duration until surgery was 5.21 day. Only three patients had any postoperative complication and nobody death. We concluded that the treatment of choice is cholecystectomia, except for high risk patient in whom puncheon and drainage is required.

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PubMed2003

[Emphysematous cholecystitis: a pathologic entity. A case report].

Emphysematous cholecystitis is a rare but real entity, which have to be recognized early in order to quickly start the best treatment. We report a case of acute emphysematous cholecystitis diagnosed with computed tomography. A successful outcome was obtained by antibiotherapy and cholecystectomy in emergency.

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PubMedDate not supplied

Emphysematous cholecystitis: sonographic findings.

BACKGROUND: Emphysematous cholecystitis (EC) is a rare but life-threatening complication of acute cholecystitis, and an early diagnosis is required to prevent delay in patient management. Because sonography (US) is the first choice for diagnosing gallbladder diseases, US findings of EC should be understood more precisely. METHODS: We reviewed US findings of 11 surgically proven cases of EC (with small amounts of gas in three cases and large amounts in eight cases) and compared those with patients' clinical data. RESULTS: (1) In cases with small amounts of gas, US showed an echogenic line with a distinct ring-down artifact or a "powder snow-like" speckled posterior echo. (2) In cases with large amounts of gas, US showed a wide spiculated echogenic band with a powder snow-like speckled posterior echo or a speckled acoustic shadowing. In all cases, the presence of gas prevented visualization of the gallbladder wall. (3) US did not differentiate gas localized to the gallbladder wall and gas extending to the surrounding hepatic tissue. (4) Two diabetic cases showed gas throughout the intrahepatic bile ducts. In those cases, the time from diagnosis to recovery was relatively long. CONCLUSION: Our series showed some characteristic US patterns of EC. A good understanding of its US findings and appropriate emergent management will reduce the serious morbidity and mortality rates caused by EC.

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PubMedDate not supplied

Percutaneous drainage of emphysematous cholecystitis associated with pneumoperitoneum.

Emphysematous cholecystitis, a relatively rare variant of acute cholecystitis, is associated with high morbidity and mortality rates. In the presence of a concomitant pneumoperitoneum, these rates may be considered even higher, approaching those of perforation of the gallbladder. The first choice of treatment in cases presenting with pneumoperitoneum is emergency laparotomy. We performed a staged procedure as a second best alternative. In a 65 year-old female patient, initial percutaneous cholecystostomy with a strict intravenous antibiotics regimen, and subsequent cholecystectomy 6 months, later was carried out with successful outcome. A review of the literature revealed 13 other cases of this combination. Treatment modalities and outcome of these patients are discussed.

Acute Disease↗
PubMed1981

[Emphysematous cholecystitis (author's transl)].

Emphysematous cholecystitis is a dangerous form of acute cholecystitis. Preoperative early diagnosis can only be made radiologically and is based on the presence of gas in the gallbladder, the gallbladder wall, or in the pericholecystic space. Cholelithiasis occurs in only 50% of cases, more often in men, significantly more frequently in diabetics. Bacteriologically, organisms of the clostridia group are predominant, but bacteriology is altogether negative in ca. 50% of cases.

Adult↗
PubMed1994

Laparoscopic cholecystectomy: safe and feasible in emphysematous cholecystitis.

We report three cases of emphysematous cholecystitis managed by laparoscopic cholecystectomy. The diagnosis was made by ultrasound in all cases. Two patients developed postoperative infections. There were no fatalities. The mean postoperative stay was 6 days. In experienced hands, laparoscopic removal of the gallbladder in emphysematous cholecystitis is feasible with good results.

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PubMed1975

[Emphysematous cholecystitis: presentation of two clinical cases].

Emphysematous cholecystitis is relatively rare: in 1971 the cumulative total of cases reported in the world literature was 115. Two cases seen in the period 1967 to 1972 can be added. The features of these two cases, and those described in the literature support the view that emphysematous cholecystitis results from a primary obliterative endarteritis and a secondary proliferation of microorganisms.

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PubMed1975

A comparative appraisal of emphysematous cholecystitis.

There is ample evidence from this retrospective comparison to indicate that emphysematous cholecystitis does merit clinical distinction apart from acute cholecystitis. It is an acute infection of the gallbladder caused by a specific group of bacteria that may be aided by some aspect of local ischemia. Cholelithiasis does not seem to be a major factor in the pathogenesis of emphysematous cholecystitis, and this, in association with some dependence upon ischemia, may account for the predominance of this disease in males rather than females. Gangrene is a common feature of the pathologic process, and thus it is not surprising that the diagnosis of emphysematous cholecystitis implies a risk of gallbladder perforation that is five times that expected from ordinary acute cholecystitis. The key to identifying this disease is the plain abdominal roentgenogram which in most instances will make the diagnosis and provide an impetus for early operative intervention.

Cholecystitis↗
PubMed1978

Gas in the bile ducts (pneumobilia) in emphysematous cholecystitis.

Gas in the biliary ducts (pneumobilia) was demonstrated in three cases of emphysematous cholecystitis. Pneumobilia is usually secondary to a spontaneous internal biliary fistula or incompetent sphincter of Oddi, and is rarely considered a manifestation of emphysematous cholecystitis. The presence of gas in the biliary ducts in these cases suggests that the cystic duct is patent, allowing gas to escape from the gallbladder lumen. The pathophysiology of emphysematous cholecystitis is discussed and an ischemic etiology considered.

Adult↗