A Case of Perforated Emphysematous Cholecystitis with Intraabdominal Free Air

• Published in: Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 39; no. 4; pp. 703 - 706
• Main Authors: Miura, Hiroshi, Fujita, Koji, Morinaga, Shojiroh, Kikunaga, Hiroyuki, Morimoto, Yosuke, Kumai, Koichiro
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society for Abdominal Emergency Medicine 31.05.2019; 日本腹部救急医学会
• Subjects: 気腫性胆囊炎; 胆囊穿孔; 腹腔内遊離ガス
• ISSN: 1340-2242; 1882-4781
• DOI: 10.11231/jaem.39.703

A 87-year-old woman visited our hospital complaining of abdominal pain with onset a week previously. She had rebound tenderness and defense in the right upper quadrant of the abdomen. Laboratory data showed elevation of inflammation markers. Abdominal CT showed air bubbles in a swollen gallbladder, intraabdominal free air, pneumobilia and gallstones. She was admitted with a diagnosis of perforated emphysematous cholecystitis and generalized peritonitis，and underwent an emergency operation. During the operation, gallbladder perforation, bile leakage and gallstones in the abdominal cavity were found. We performed a subtotal cholecystectomy. Bilious ascites culture showed the inflammation had been caused by Escherichia coli. Pathological examination of the gallbladder revealed gangrenous cholecystitis. Surgical site infection occurred in day 6 which was treated with antibiotics, otherwise the postoperative course was uneventful. There have been 13 cases of cholecystitis with intraabdominal free air reported in Japan.