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"Nodules - But Where? |
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Case of the Week 257 
What's the most likely diagnosis?
- 62 year-old male with right upper quadrant pain
- Situs inversus
- Free air
- Splenic artery aneurysm
- Emphysematous cholecystitis
- Volvulus
Answer:
4. Emphysematous cholecystitis
More (Click Discussion Tab)
Emphysematous Cholecystitis
General Considerations
- Acute infection of gallbladder caused by gas-forming organism
- In about 1/3 = clostridium perfringens
- Also E. Coli and Klebsiella
- Rare – only 1% of all cases of acute cholecystitis
- Occurs more often in men
- As opposed to gallbladder disease in general which occurs more often in women
- Mostly are elderly patients (>60) with diabetes
- Vascular compromise of the cystic artery may play a role in the etiology
- Gallstones may be associated with the disease but are not thought to cause it
- Gas may occur in the wall and/or the lumen
- May spread to pericholecystic tissue
- Rarely, gas may escape into the bile ducts
- This is rare since cystic duct is usually occluded in cholecystitis
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