Fact-sheet: Emphysematous cholecystitis
Updated on 04/20/2018 at 5:36 PM
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Definition
Rare form of acute cholecystitis.
Population at risk: diabetic patients over 50 years old (20-50% of cases).
Secondary to anaerobic infection (C. perfringens) combined with arterial ischemic phenomena.
Course: gangrene, perforation (20% of cases)
Mortality: 15% of cases
Clinical features
- Fever
- Right upper quadrant pain radiating to the tip of the right scapula
- Positive Murphy sign
Laboratory findings
- Neutrophilic hyperleukocytosis
CT
- Wall thickening with variable mucosal enhancement after injection, reflecting ischemia
- Gas within the gallbladder and/or gallbladder wall
- Hepatic hyperenhancement adjacent to the gallbladder
- Pericholecystic fluid collection
- Gallbladder sludge / gallstones
Differential diagnosis
- Cholecystoenteric fistula
- Pneumobilia following sphincterotomy or biliary-enteric anastomosis.