Two Cases of Acute Emphysematous Cholecystitis

Akira Suzuki, Jin-ichi Kameyama, Yousuke Sakai, Shun Kudou, Akiko Takeshita, Hiroshi Kuzu*, Masahiro Urayama*, Kiyoshi Kawaguchi*

Department of Surgery, Yamagata Prefectural Nihonkai Hospital
*First Department of Surgery, Yamagata University School of Medicine

Acute emphysematous cholecystitis is a rare disease caused by gasproducing bacteria. Abdominal imaging examinations reveal abnormal gas in the gallbladder lumen and pericholecystic space. We experienced two cases of acute emphysematous cholecystitis. Case 1: A 68-year-old man. He was admitted to our hospital because of upper abdominal pain. Abdominal imagings showed air in the gallbladder and he was diagnosed as having acute emphysematous cholecystitis. He was treated with intravenous fluids and antibiotics, and then his general condition improved. A cholecystectomy was performed 18 days after admission. Pathological examination of the surgical specimen revealed acute gangrenous cholecystitis. By cultivation of bile juice collected during the operation, Clostridium species was detected. Case 2: An 85-year-old man. He was admitted to our hospital because of upper abdominal pain. Abdominal imagings showed air in the gallbldder and the bile duct. With a diagnosis of acute emphysematous cholecystitis, percutaneous transhepatic gallbladder drainage was immediately performed, however, it was unsusuccessful. On the day of admission emergency laparotomy was carried out. The histopathological findings of the gallbladder showed phlegmonous inflammation. Culture of the bile was positive for Clostridium perfringens. In these two cases the postoperative course was good, and the patients were discharged on the 14th and 16th postoperative days respectively.

Key words
emphysematous cholecystitis, gas-producing bacteria, cholecystectomy

Reprint requests
Akira Suzuki Department of Surgery, Yamagata Prefectural Nihonkai Hospital
30 Akiho-cho, Sakata-city, 998 JAPAN

Accepted
September 9, 1997

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