A case of acute emphysematous cholecystitis with typical imaging findings

Acute emphysematous cholecystitis is a rare disease caused by organisms that produce gas that leaks into the gallbladder lumen and becomes visible on imaging examinations. Here, we report a case of acute emphysematous cholecystitis with a typical presentation. A 73-year-old woman presented with abdominal pain to the emergency department at our hospital. Her temperature was 37.6 ℃ and blood pressure was 126/71mm Hg. On physical examination, her abdomen was flat, soft, and diffusely tender without muscular guarding or rebound tenderness. Laboratory data revealed the following: WBC 12300/mm^3, CRP 7.30 mg/dL, T-bil 1.5 mg/dL, AST 512 IU/L, ALT 297 IU/L, γ-GTP 110 IU/L, ALP 401 U/L. Abdominal ultrasound scan, plain abdominal film, and abdominal computed tomographic images demonstrated gas within the gallbladder wall and intrahepatic ducts. The symptoms and image findings suggested acute emphysematous cholecystitis. Percutaneous transhepatic gallbladder drainage was performed immediately to confirm the diagnosis. Clostridium perfringens was identified in bile culture. We performed laparoscopic cholecystectomy after the patient's general condition improved.