A Case of Emphysematous Cholecystitis with Portal Venous Gas and Pneumobilia

Tomoyuki Wakahara, Akihiro Toyokawa, Shohei Komatsu, Kenichi Tanaka, Tadashi Tsukamoto, Yutaka Hamabe, Takeshi Ishida and Kazuhiro Teramura*

Department of Surgery and Department of Pathology*, Yodogawa Christian Hospital

Emphysematous cholecystitis is a variant of acute cholecystitis characterized by intraluminal and intramural gas of the gall bladder. Several reports of emphysematous cholecystitis have been associated with pneumobilia, although it is rare. Portal venous gas is generally detected under different abdominal conditions, including infarcted bowel, but portal venous gas caused by emphysematous cholecystitis is extremely rare. We discuss a rare case of emphysematous cholecystitis associated with pneumobilia and portal venous gas. A 79-year-old man with general fatigue and appetite loss was found on physical examination to have diffuse abdominal tenderness with severe tenderness in the upper right quadrant. Abdominal computed tomography showed gas in the gall bladder and its wall, pneumobilia, and portal venous gas without findings in other abdominal viscera, including the bowel. Based on a diagnosis of panperitonitis caused by emphysematous cholecystitis, we conducted emergency open cholecystectomy. The patient had to spend several days in the intensive care unit thereafter, but the postoperative course was essentially uneventful.

Key words
emphysematous cholecystitis, pneumobilia, portal venous gas

Reprint requests
Tomoyuki Wakahara Department of Surgery and Department of Pathology, Yodogawa Christian Hospital
2-9-26 Awaji, Higashi Yodogawa-ku, Osaka, 533-0032 JAPAN

Accepted
September 27, 2006

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