Emphysematous Cholecystitis: A Brief Report Demonstrating the Pertinence of Timely Diagnosis

Etiology of acalculous emphysematous cholecystitis is postulated to be due to acute on chronic diseases and low flow arterial state, as known risk factors to the disease include diabetes mellitus and peripheral arterial disease. 1 Diagnosis is easily made with a CT scan, which is the gold standard with 100% sensitivity, and demonstrates gas within the walls of the gallbladder, adjacent tissues, and/or biliary ducts. 3 Plain X-ray and ultrasound are other modalities for diagnostic purposes, although they have been found to be less sensitive than CT. 4 Features indicative of emphysematous cholecystitis on plain X-ray are similar to that of CT with gas noted in the biliary structures. A magnetic resonance imaging (MRI) can also be obtained, which would show a hypodense ring around the gallbladder, but due to the emergent nature of the disease, it is not preferred over other imaging modalities. 3 The treatment of choice includes emergent cholecystectomy either via an exploratory laparotomy or minimally invasive approach, depending on hemodynamic stability. 1 If the patient is considered to be high risk for death or complications, a percutaneous cholecystostomy tube may be performed complemented by broad-spectrum antibiotics.