Abstract
We report an 84-year-old man with perforation caused by emphysematous cholecystitis who showed flare on the skin of the right dorsal lumbar region and intraperitoneal free gas. The patient was admitted for abdominal pain, abdominal swelling, and consciousness disorder 18 days after the onset. Abdominal computed tomography (CT) revealed emphysema in the gallbladder and a small amount of intraperitoneal free gas. Intraoperative findings suggested gangrenous cholecystitis. The gallbladder wall was perforated, and an abscess involving the right subphrenic region, the periphery of the liver and gallbladder, and the right paracolonic groove, was detected. The flare on the body surface may have reflected abscess formation in the right abdominal cavity. Emphysematous cholecystitis induces necrosis and perforation in many patients, and immediate strategies such as emergency surgery are important.
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References
Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, et al. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg 2007;14:78–82.
Garcia-Sancho Tellez L, Rodriguez-Montes JA, Fernandez de Lis S, Garcia-Sancho Martin L. Acute emphysematous cholecystitis. Report of 20 cases. Hepatogastroenterology 1999;46:2144–2148.
Zeebregts CJ, Wijffels RT, de Jong KP, Peeters PM, Slooff MJ. Percutaneous drainage of emphysematous cholecystitis associated with pneumoperitoneum. Hepatogastroenterology 1999;46:771–774.
Coulier B, Cloots V. Images in clinical radiology. Extensive emphysematous cholecystitis. JBR-BTR 1999;82:245.
Yoshida K, Arakawa M, Ishida S, Sasaki Y. A case of hemolytic syndrome associated with emphysematous cholecystitis and a liver abscess. Tohoku J Exp Med 1998;185:147–155.
Ochiai T, Yamazaki S, Ohta K, Takahashi M, Iwai T, Irie T, et al. Is drip infusion cholecystocholangiography(DIC) an acceptable modality at cholecystectomy for cholecystolithiasis, considering the frequency of bile duct maljunction and intraoperative bile duct injury? J Hepatobiliary Pancreat Surg 2004;11:135–139.
Gill KS, Chapman AH, Weston MJ. The changing face of emphysematous cholecystitis. Br J Radiol 1997;70:986–991.
Kubota K, Abe Y, Inamori M, Kawamura H, Kirikoshi H, Kobayashi N, et al. Percutaneous transhepatic gallbladder stenting for recurrent acute acalculous cholecystitis after failed endoscopic attempt. J Hepatobiliary Pancreat Surg 2005;12:286–289.
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Kanehiro, T., Tsumura, H., Ichikawa, T. et al. Patient with perforation caused by emphysematous cholecystitis who showed flare on the skin of the right dorsal lumbar region and intraperitoneal free gas. J Hepatobiliary Pancreat Surg 15, 204–208 (2008). https://doi.org/10.1007/s00534-007-1224-7
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DOI: https://doi.org/10.1007/s00534-007-1224-7