Emphysematous cholecystitis

a rare but life-threatening form of acute cholecystitis characterized by air within the gallbladder wall that is caused by gas-forming bacteria (e.g., Clostridium spp., E.coli)

rare; most commonly seen in elderly diabetic men (esp. 50–70 years of age)

• Similar to acute calculous cholecystitis: fever, RUQ pain, referred pain

• Symptoms progress rapidly. [10]

• Associated with early gangrene and gallbladder perforation

• Laboratory studies and findings: similar to those of acute calculous cholecystitis

• Imaging: The characteristic feature of EC on imaging is air within the gallbladder wall or lumen.

  • RUQ ultrasound

  • Noncontrast CT abdomen

• Initial supportive management: NPO, IV fluids, analgesics (see ''Treatment'' section)

• Broad-spectrum IV antibiotics with anaerobic coverage

• Emergency source control procedure

  • Low-risk patients: emergency laparoscopic cholecystectomy

  • High-risk patients: gallbladder drainage