Presentation
Acute abdomen
Patient Data
An air-fluid level is seen within the GB with a surrounding radiolucent halo of air.
The gall bladder is distended with an air-fluid level. A halo of air is seen within the substance of the gall bladder wall with a focal area of wall interruption and extravasation of air into the adjacent hepatic parenchyma. There is associated peri-cholecystic collection and stranding of fat planes. Few air foci are noted within the hepatic biliary radicles consistent with pneumobilia. Scanned lung bases revealed bilateral pleural effusion with underlying consolidation.
24-hour follow-up post-cholecystostomy revealed a regressive course regarding the distended GB with an air-fluid level. The GB now is collapsed with the pig-tail catheter seen in situ.
A follow-up radiograph showing the cholecystostomy tube within the substance of the GB bed with complete resolution of the air-fluid level. Note the residual streaks of air seen at the gall bladder bed.
Case Discussion
Emphysematous cholecystitis is a severe form of acute cholecystitis. Mortality is up to 15% compared to the non-emphysematous type of cholecystitis. It usually occurs in the elderly especially those with diabetes. The primary underlying pathology is ischemic changes of the gall bladder wall due to atherosclerosis. The primary causative organisms are Clostridium, E-coli, and Klebsiella. Percutaneous cholecystostomy can serve as an alternative if surgery is contraindicated.
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