A Case of Acute Obstructive Suppurative Cholangitis Complicated with the Retroperitoneal Emphysema

Hideo Tohira, Ken-ichiro Tateyama and Yutaka Ozeki

Department of Surgery, National Tosei Hospital

A 72-year-old female were admitted to a clinic with complaint of epigastric pain, and suspected as acute cholecystitis, then transferred to our hospital. On the first day after admission the symptom was deteriorated and we performed percutaneous transhepatic gallbladder drainage to prevent exacerbation of the symptom and aspirated suppurative bile. On the next day biochemistry tests revealed that total bilirubin was 15.9 mg/dl and Pentalogy of Raynolds was observed, then we diagnosed acute obstructive suppurative cholangitis with GB stone. On the same day a CT was taken and it demonstrated retroperitoneal emphysema with alveolar pattern at just cranial side of the pancreas. On the 7^th day after admission, we performed a laparotomy to eliminate the cause of the cholangitis, a gallbladder and gallstones. We also investigated the retroperitoneal emphysema, and as a result we found the retroperitoneum filled with necrotic tissue without abscess. We decided the cause of the retroperitoneal emphysema was infection due to the cholangitis. The patient was discharged on the 77^th day after admission. The retroperitoneal emphysema due to acute obstructive suppurative cholangitis has not been reported in this country yet, and we herein reported such a rare case.

Key words
acute obstructive suppurative cholangitis, retroperitoneal emphysema

Reprint requests
Hideo Tohira Osaka Prefectural Senshu Critical Care Medical Center 2-24 Rinku-Orai Kita, Izumisano, 598-0048 JAPAN

Accepted
September 22, 1999

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