Postoperative gangrenous peritonitis after laparoscopic cholecystectomy: a new complication for a new technique

We report a case of anaerobic peritonitis with bowel emphysema, but no hollow organ perforations, following gallbladder removal for acute acalculous cholecystitis using a laparoscopic procedure in a diabetic patient. Management consisted of profuse peritoneal irrigation and zipper laparostomy. After a long postoperative period, the patient recovered without sequelae. The patient suffered typical acute cholecystitis with empyema and a diabetic status; anaerobial flora is frequent in these cases. The patient was operated on by means of a closed technique without contact with either air or oxygen. Moreover, CO2 injection into the peritoneal cavity with this technique, along with gallbladder rupture, created an ideal medium for anaerobial growth. We suggest that acalculous cholecystitis in diabetic patients could represent a contraindication for laparoscopic cholecystectomy; alternatively, open cholecystectomy should at least be considered when gallbladder rupture occurs during laparoscopy.