title: [Acute emphysematous cholecystitis as a cause of pneumoperitoneum].
abstract: A 48-year-old man developed progressively more severe epigastric pain, pain on pressure in the right upper abdomen and fever up to 38.6 degrees C so that acute cholecystitis was suspected. Ultrasound did not demonstrate a gall-bladder but a sickle shaped, dense echo with a distal adjoining echo-free zone. Computed tomography revealed air in the gall-bladder lumen as well as intramural and pericholecystic air pockets, findings pathognomonic for emphysematous cholecystitis. In addition pneumoperitoneum was diagnosed. Subsequent cholecystectomy intraoperatively revealed a gangrenous, nonperforating gall-bladder in which E. coli was demonstrated. During the first postoperative week, there were no complications under transitory antibiotic treatment with tobramycin and ticarcillin with clavulanic acid. Then, an abscess developed in the residual gall bladder bed; this abscess was cured after drainage, local irrigation and re-initiation of antibiotic treatment. The patient was finally discharged well.
authors.affiliation: II. Medizinische Klinik, Universität Mainz.
authors.forename: P P
authors.initials: PP
authors.lastname: Urban
authors.forename: H
authors.initials: H
authors.lastname: Schinzel
authors.forename: L S
authors.initials: LS
authors.lastname: Weilemann
authors.forename: A
authors.initials: A
authors.lastname: Brunier
mesh_terms: D000038:Abscess / Q000209:etiology / Q000628:therapy; D000208:Acute Disease; D002763:Cholecystectomy; D002764:Cholecystitis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D019818:Clavulanic Acid; D002969:Clavulanic Acids / Q000627:therapeutic use; D004322:Drainage; D005705:Gallbladder Diseases / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011027:Pneumoperitoneum / Q000209:etiology*; D011183:Postoperative Complications / Q000517:prevention & control; D007507:Therapeutic Irrigation; D013982:Ticarcillin / Q000627:therapeutic use; D014031:Tobramycin / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D002969:Clavulanic Acids; D019818:Clavulanic Acid; D013982:Ticarcillin; D014031:Tobramycin
vernacular_title: Akute emphysematöse Cholezystitis als Ursache eines Pneumoperitoneums.