Acute Emphysematous Cholecystitis with Gas Extension to Pericholedocal and Posterior Pancreatic Tissues

A 70-year-old man with a past history of diabetes mellitus and hypertension was admitted to our hospital with a 2 day history of right hypochondralgia, nausea, vomiting and fever. Examination revealed tenderness and muscle guarding in the right upper quadrant of the abdomen. Plain abdominal X-ray showed an area of gas in the region of the gallbladder. Abdominal CT revealed gas in the wall of the gallbladder, and also in the pericholedocal and posterior pancreatic tissues. A diagnosis of acute emphysematous cholecystitis was made. The patient was treated with intravenous fluids and antibiotics. He improved after these treatments. Cholecystectomy was performed on the 11th hospital day. Pathologic examination of the surgical specimen revealed acute gangrenous cholecystitis. The postoperative course was uneventful. He was discharged on the 13th postoperative day. There has been no report of emphysematous cholecystitis with gas extension to the pericholedocal and other surrounding tissues in the Japanese literature.