Emphysematous Cholecystitis a Rare and Serious Clinical Entity: A Case Report of 6 Patients

Abstract

Introduction: Emphysematous cholecystitis or pneumocholecystitis is a condition caused by gas-forming microorganisms that cause ischemia and necrosis of the vesicular wall. It is characterized by the presence of gas in the wall and lumen of the gallbladder. Its incidence is higher in diabetics. It is a rare disease entity responsible for high mortality. However, early diagnosis combined with prompt and appropriate treatment can prevent the progression to septic shock and then death. The objective of this study was to describe the diagnostic and prognostic aspects, in order to enrich the limited literature concerning this pathology. Patients and methods: This was a descriptive retrospective study that ran from January 2019 to December 2021. It concerned patients admitted for emphysematous cholecystitis. Results: We collected 6 records of patients admitted for 6 emphysematous cholecystitis. They accounted for 1.8% of all cholecystectomies (n=278) and 4% of emergency cholecystectomies (n=112). These were 4 men (67%) and 2 women (33%). The mean age was 76.4 years. Patients generally had several histories, including the hypertension-diabetes couple, but 1 patient did not have diabetes. The average consultation time was 3 days. The clinical picture was acute generalized peritonitis in 1 patient and localized irritation to the right hypochondrium in 5 patients with septic shock. The diagnosis in all patients was made by abdominal CT scan. One patient had an ASA IV score, the other 5 patients had a score from ASA to III. In all cases, after intense resuscitation, cholecystectomy was performed, of which four (67%) were performed laparoscopically and 2 (33%) were performed by laparotomy. Bacteriology of bile fluid revealed gram-negative baccilia (E. coli, Citrobacter koseri) and gram-positive cocci (staphylococcus aerus) in 5 cases and 1 case of sterile fluid. The mean length of hospital stay was 5 days (range: 5-18 days). The morbidity was a case of parietal suppuration treated with local dressing. No deaths. Conclusion: Rare pathology. Diagnosis is essentially based on imaging, in this case abdominal CT scans. The prognosis depends on early and appropriate medical-surgical management.