Emphysematous Cholecystitis

A 74-year-old man, with a prior history of type 2 diabetes mellitus, a supracondileal amputation of the left leg and admissions for heart failure and acute renal failure, was admitted to the Emergency Department for abdominal pain of 4 days duration, located in the right upper quadrant, with nausea, fever and vomiting. On physical examination, T.^a: 37.6 °C, the abdomen was painful in the right upper quadrant, with signs of peritoneal irritation. Blood tests revealed leukocytosis of 20 100; CRP 40 and prothrombin activity 53%. An abdominal X-ray was performed (Fig. 1) showing an image of the gallbladder surrounded by air in the right upper quadrant. An ultrasound confirmed emphysematous cholecystitis.

Fig. 1