Emphysematous Cholecystitis

Emphysematous Cholecystitis

• Emphysematous cholecystitis caused by proliferation of gas-forming organisms e.g., Clostridium perfringens (commonest- MCQ), Escherichia coli after vascular compromise of the gallbladder.
• It is characterized by gas accumulation in the gallbladder lumen, wall, or pericholecystic tissue a rare but serious manifestation of acute cholecystitis. 
• It is most common in older patients with diabetes
• A diagnosis of emphysematous cholecystitis can be confirmed with plain radiography, ultrasonography, or CT. Plain radiography may be sufficient but has low sensitivity early in the disease. Ultrasound findings suggestive of the condition depend on the amount and location of the gas.
• CT is the most definitive modality when findings on plain radiography or ultrasonography are equivocal.
• Emphysematous cholecystitis requires immediate cholecystectomy and broad-spectrum antibiotic therapy (Has a mortality rate of 15%).
• If patient is unfit then urgent CT or USG guided per-cutaneous cholecystostomy should be done drain pus and control infection. Later on interval cholecystectomy done when patient is fit.

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