title: Emphysematous cholecystitis with massive gas in the abdominal cavity.
abstract: Emphysematous cholecystitis is a rare variant of acute cholecystitis with a high mortality rate. The combination of emphysematous cholecystitis and pneumoperitoneum is also rare. We herein describe a case of emphysematous cholecystitis with massive gas in the abdominal cavity. A 77-year-old male presented with epigastric pain and lassitude lasting for one week. A computed tomography scan demonstrated massive gas in the abdominal cavity. Gas was also detectable inside the gallbladder. Massive ascites as well as a pleural effusion were also detected. Under the diagnosis of perforation of the digestive tract, we performed emergency surgery. Beyond our expectations, the perforation site was not in the alimentary tract, but rather in the gallbladder. We then diagnosed the patient with emphysematous cholecystitis with perforation, and performed cholecystectomy. A pathological examination of the resected gallbladder revealed necrosis in the mucosa and thinning of the wall. Cultures of the ascites detected Clostridium perfringens, a gas-producing microorganism.
authors: Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo 1308575, Japan.
authors: Hiroyuki
authors: H
authors: Miyahara
authors: Dai
authors: D
authors: Shida
authors: Hiroki
authors: H
authors: Matsunaga
authors: Yukiko
authors: Y
authors: Takahama
authors: Sachio
authors: S
authors: Miyamoto
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001202:Ascitic Fluid / Q000382:microbiology; D002763:Cholecystectomy; D003015:Clostridium Infections / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000601:surgery; D003016:Clostridium perfringens / Q000302:isolation & purification; D041882:Emphysematous Cholecystitis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000601:surgery; D005704:Gallbladder / Q000382:microbiology / Q000601:surgery; D006801:Humans; D008297:Male; D011027:Pneumoperitoneum / Q000209:etiology; D012422:Rupture, Spontaneous; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Clostridium perfringens; Emphysematous cholecystitis; Pneumoperitoneum
references: Am J Surg. 2010 Oct;200(4):e53-4
references: 20887835
references: Hepatogastroenterology. 1999 Mar-Apr;46(26):771-4
references: 10370609
references: N Engl J Med. 2007 Sep 20;357(12):1238
references: 17881755
references: J Hepatobiliary Pancreat Surg. 2008;15(2):204-8
references: 18392716
references: Chir Ital. 2008 Mar-Apr;60(2):315-8
references: 18689185