title: An 86-year-old man with acute abdominal pain.
abstract: An 86-year-old man presented with severe pain in the upper abdomen along with fever. On physical examination, we found an arterial blood pressure of 84/43 mm Hg, a heart rate of 80 bpm and a temperature of 38.3°C. The abdomen was painful and peristalsis was absent. Empiric antibiotic therapy for sepsis was started with amoxicillin/clavulanate and gentamicin. CT scan of the abdomen revealed an emphysematous cholecystitis. Percutaneous ultrasound-guided cholecystostomy was applied. Bile cultures revealed Clostridium perfringens. Emphysematous cholecystitis is a life-threatening form of acute cholecystitis that occurs as a consequence of ischaemic injury to the gallbladder, followed by translocation of gas-forming bacteria (ie, C. perfringens, Escherichia coli, Klebsiella and Streptococci). The mortality associated with emphysematous cholecystitis is higher than in non-emphysematous cholecystitis (15% vs 4%). Therefore, early diagnosis with radiological imaging is of vital importance.
authors: Department of Internal Medicine, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.
authors: Paul M E L
authors: PM
authors: van Dam
authors: Department of Internal Medicine, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.
authors: Dirk
authors: D
authors: Posthouwer
mesh_terms: D015746:Abdominal Pain / Q000382:microbiology*; D000369:Aged, 80 and over; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001646:Bile / Q000382:microbiology; D002767:Cholecystostomy / Q000379:methods*; D003016:Clostridium perfringens; D041882:Emphysematous Cholecystitis / Q000382:microbiology / Q000628:therapy*; D005704:Gallbladder / Q000293:injuries / Q000382:microbiology / Q000601:surgery; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011860:Radiography, Abdominal; D018805:Sepsis / Q000188:drug therapy / Q000382:microbiology; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D019980:Amoxicillin-Potassium Clavulanate Combination