Emphysematous cholecystitis: report of a case.

Area of Science:

• Gastroenterology
• Surgical Case Reports
• Abdominal Surgery

Background:

• Emphysematous cholecystitis is a severe gallbladder inflammation characterized by gas formation within the gallbladder wall and lumen.
• It is a rare but life-threatening condition, often associated with diabetes mellitus and biliary obstruction.
• Previous gastric surgery, such as vagotomy and hemigastrectomy with Billroth II reconstruction, may alter the gastrointestinal environment and potentially predispose to such complications.

Observation:

• A case of emphysematous cholecystitis is presented in a patient seven months post-vagotomy and hemigastrectomy with Billroth II reconstruction.
• The patient presented with clinical signs suggestive of acute cholecystitis.
• Imaging studies confirmed the presence of gas within the gallbladder, consistent with emphysematous cholecystitis.

Findings:

• The patient underwent an initial cholecystostomy for drainage and management of sepsis.
• A subsequent cholecystectomy was performed six weeks later, after the patient's overall clinical condition improved.
• This staged surgical approach was successful in treating the emphysematous cholecystitis.

Implications:

• This case highlights that while emphysematous cholecystitis often necessitates urgent surgical intervention, a tailored approach considering the patient's overall clinical status and surgical history is crucial.
• The management strategy, including initial drainage followed by definitive surgery, can be effective in selected cases, even after complex gastric reconstructions.
• Further research into the specific risk factors and optimal management strategies for emphysematous cholecystitis in post-gastric surgery patients is warranted.