Authors: Dr Nursyafiqah Mohd Noor , Dr Mohammad Fathullah Rossman

Abstract

Emphysematous cholecystitis (EC) is a rare but severe form of acute cholecystitis, distinguished by the presence of gas within the gallbladder wall, lumen, or surrounding tissues. It predominantly affects elderly, diabetic, and immunocompromised individuals and carries a significantly higher risk of complications and mortality compared to typical acute cholecystitis.

 A case study shown a 70 years old lady with comorbid of hypertension and hyperlipidemia presented to emergency department with two days history of abdominal pain which more over the epigastric region radiated to the right side with concurrent episodes of vomiting. She was also complaining of  having loose stool for the past two days . However , no fever was documented . Upon examining her,  vital sign was stable ,however in the abdomen, there was tenderness over the right iliac fossa with positive Murphy sign.Bedside transabdominal ultrasound of the gallbladder revealed mixed hypoechogenicity over the liver segment II surrounding the gallbladder with sludge and stone seen within . The common bile duct was dilated.She was then proceed to CECT which  revealed distended gallbladder with thickened gallbladder wall measuring 0.5 cm in thickness. Calculus seen within the gallbladder measuring 1.6cm x 1.7 cm with heterogeneous and enhancing pericholecystic fluid. Multiple areas of wall defect also detected .

These findings suggestive of perforation. Infective markers showed raised in inflammatory cells which indicate infection.  She was then initially treated with antibiotics and subsequently proceed to open cholecystectomy to remove the gallbladder. Her condition improved tremendously after antibiotics and surgical intervention . She was then discharged well soon after.

Keywords: Emphysematous cholecystitis ,EC, high mortality ,gallbladder gangrene, gallbladder perforation