EMPHYSEMATOUS CHOLECYSTITIS: A DO-IT-YOURSELF CHOLECYSTECTOMY AND THE IMPORTANCE OF EARLY SURGICAL TREATMENT beatrizcordeiro8@hotmail.com

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EMPHYSEMATOUS CHOLECYSTITIS: A DO-IT-YOURSELF CHOLECYSTECTOMY AND THE IMPORTANCE OF EARLY SURGICAL TREATMENT

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Hugo Capote hugo.capote@ulsaale.min-saude.pt Unidade Local de Saúde do Alto Alentejo - Hospital Doutor José Maria Grande General Surgery Portalegre Portugal

 

 

 

Portugal

Oral or Poster

Emphysematous cholecystitis (EC) occurs in 1-4% of acute cholecystitis, resulting from the invasion of the gallbladder by gas-producing bacteria. If left untreated EC can progress to gangrenous cholecystitis and lead to a mortality rate of up to 20%. This case report illustrates the importance of early surgical treatment.

Case report and literature revision of EC.

86-year-old female with 1 week of right upper abdominal pain. Diagnosed through US with acute cholecystitis and started on ciprofloxacin by general practitioner. In the emergency department, she had normal WBC and RCP of 371 mg/L. Her CT scan showed EC with perihepatic liquid with an air bubble. With no US window for percutaneous drainage, she was started on Piperacilin-Tazobactam for conservative treatment. Due to fever, she repeated the CT scan on day 3, showing a perihepatic abscess. She was submitted to laparoscopic cholecystostomy and abscess drainage on day 4. On day 6 the patient worsened and the abscess drainage became biliary. She was submitted to cholecystectomy on day 7. Intraoperatively, we found a biliary peritonitis with a gangrenous gallbladder unattached to the vesicular fossa and cystic duct. Due to inability to safely visualize the cystic duct, a drain was placed and she underwent later ERCP with stent placement in the common bile duct. She improved and was discharged on the 19th day.

EC is rare condition and as this case report highlights an early cholecystectomy can prevent its evolution to gangrenous cholecystitis or gallbladder perforation.