A case of emphysematous cholecystitis managed by laparoscopic surgery.
BACKGROUND
Emphysematous cholecystitis is a rare condition caused by ischemia of the gallbladder wall with secondary gas-producing bacterial proliferation. The pathophysiology and epidemiology of this condition differ from that in gallstone-related acute cholecystitis. This report illustrates a case of emphysematous cholecystitis successfully treated by laparoscopic surgery.


METHODS
An 83-year-old female patient was admitted to the hospital with acute abdominal syndrome. Clinical examination and blood tests suggested acute cholecystitis. Plain radiography revealed a circular gas pattern in the right upper quadrant suggestive of emphysematous cholecystitis. Subsequent computed tomography confirmed the presence of gas in the gallbladder wall and a gas-fluid level within the organ.


RESULTS
Emergency laparoscopic cholecystectomy was successfully performed during which bubbling of the gallbladder wall was observed. Intraoperative cholangiography revealed no bile duct stones or biliary obstruction. The patient made an unremarkable recovery from surgery with no postoperative complications or admission to the intensive care unit. Pathological analysis revealed full-thickness infarctive necrosis of the gallbladder. Bacterial cultures grew Clostridium perfringens.


CONCLUSIONS
This case illustrates a typical case of emphysematous cholecystitis successfully treated by laparoscopic surgery. It contributes to suggestions from other reports that this condition can be safely treated by the laparoscopic approach.
Bouras
George
G
IRCAD, Louis Pasteur University, Strasbourg France. GeorgeBouras@hotmail.com
Lunca
Sorinel
S
Vix
Michel
M
Marescaux
Jacques
J
D000369:Aged, 80 and over; D003015:Clostridium Infections / Q000150:complications; D004638:Emergency Treatment; D041882:Emphysematous Cholecystitis / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D005260:Female; D005704:Gallbladder / Q000382:microbiology / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D009336:Necrosis; D011859:Radiography