Copyright 2008
Definition
Emphysematous cholecystitis is the accumulation of air in the gallbladder, without the presence of a fistulous tract to the intestinal lumen. It is associated with infection by gas-producing flora, also called gangrenous cholecystitis.
It is a rare form of acute cholecystitis that presents identically to non-gangrenous acute cholecystitis.
Structurally, there is a presence of inflammation and distention of the wall of the gallbladder, accompanied often by fluid collection around.
It is however associated with an increased tenderness (either by manual palpation or sonographic Murphy’s sign), and an increased mortality of nearly 22% and increased complications.
In addition to the complications of acute cholecystitis, gangrene is a possible complication.
Diganosis can be made with plain film, showing an air-fluid interface along the wall of the enlarged gallbladder, though abdominal CT is more sensitive.
The most common bacteria associated with this are anaerobes, and sometimes gram-negative rods.
Emphysematous Cholecystitis |
| This is a plain film of the abdomen showing air outlining the gallbladder. This indicates infection by gas-forming and that the gallbladder is at great risk for perforation. The changes here are subtle, but careful inspection will reveal the distended gallbladder outlined by a thin black rim, indicating the air around the gallbladder.
11928.8s gallbladder emphysematous cholecystitis X-ray Courtesy Barbara Banner MD |
Emphysematous Cholecystitis |
| 16195c02.8s elderly patient with heart disease and significant atherosclerotic disease gallbladder lumen is filled with air wall linear air collection bubbles of air air fluid level dx emphysematous cholecystitis CTscan Courtesy Ashley Davidoff MD copyright 2008 |
Emphysematous Cholecystitis |
| 61 year old who presents with abdominal pain, acute inferior myocardial infarction, with a background history of type II diabetes 31093 Courtesy Ashley Davidoff MD code pancreas fx induration dx acute pancreatitis code gall bladder wall fx air dx emphysematous cholecystitis size |
Emphysematous Cholecystitis |
| 61 year old who presents with abdominal pain, acute inferior myocardial infarction, with a background history of type II diabetes
31095c Courtesy Ashley Davidoff MD code pancreas fx induration dx acute pancreatitis code gall bladder wall fx air dx emphysematous cholecystitis size |
Emphysematous Cholecystitis |
| 00403 gallbladder + lumen + fx air + wall + dx emphysematous cholecystitis + abdominal plain film KUB imaging radiology emergency |
Emphysematous Cholecystitis |
| 04537c02s air in the gallbladder wall air in the lumen dx emphysematous cholecystitis gallbladder wall lumen plain X-ray lateral abdominal projection Courtesy Ashley DAvidoff MD copyright 2008 |
Emphysematous Cholecystitis |
| 04541c01s air in the gallbladder wall air in the lumen air fluid level dx emphysematous cholecystitis gallbladder wall lumen plain X-ray decubitus right side up lateral abdominal projection Courtesy Ashley DAvidoff MD copyright 2008 |
Emphysematous Cholecystitis |
| 04641b.8s gunshot wound to the abdomen gallbladder air in wall emphysematous cholecystitis fragments of bullet plain X-ray Courtesy Ashley Davidoff MD Copyright 2008 |
Emphysematous Cholecystitis |
| 04641c01.8s gunshot wound to the abdomen gallbladder air in wall emphysematous cholecystitis fragments of bullet plain X-ray Courtesy Ashley Davidoff MD Copyright 2008 |
Emphysematous Cholecystitis |
| 82384.6ks 78M air in gallbladder wall abdominal pain emphysematous cholecystitis CTscan copyright 2008 Courtesy Ashley Davidoff MD |