Acute emphysematous cholecystitis associated with pneumobilia: a case report

Area of Science:

• Gastroenterology
• Abdominal Surgery
• Infectious Diseases

Background:

• Acute emphysematous cholecystitis is a rare, severe form of acute cholecystitis characterized by gallbladder wall necrosis and gas formation.
• Pneumobilia, the presence of gas in the biliary tree, is an uncommon finding in emphysematous cholecystitis, suggesting a fistula or specific bacterial involvement.

Observation:

• A 66-year-old female patient with a history of diabetes mellitus, gastric, and breast carcinoma presented with right upper quadrant pain and gallbladder distention.
• Laboratory findings revealed leukocytosis, elevated C-reactive protein (CRP), jaundice, liver dysfunction, and hyperglycemia.
• Imaging (X-ray and CT) confirmed gas within the gallbladder and a small amount in the common bile duct.

Findings:

• Percutaneous transhepatic gallbladder drainage (PTGBD) was performed, and bile cultures identified Clostridium perfringens and E. coli.
• Post-PTGBD imaging excluded cystic duct obstruction.
• The patient underwent successful cholecystectomy and choledochotomy with primary closure on postoperative day 12.

Implications:

• This case highlights the importance of prompt diagnosis and management of acute emphysematous cholecystitis, even with unusual findings like pneumobilia.
• The successful outcome underscores the efficacy of a combined approach involving initial drainage followed by definitive surgical intervention.
• Early recognition and treatment are crucial for improving patient outcomes in this potentially life-threatening condition.