EP-277 Emphysematous cholecystitis: A diagnostic dilemma and treatment challenge

Abstract

Background Emphysematous cholecystitis (EC) is a rare life-threatening variant of acute cholecystitis. It is commonly seen in elderly men who are immunocompromised, known diabetes mellitus or peripheral vascular disease. EC is caused by gas-forming organisms such as Escherichia coli, Clostridium perfringens and Bacteroides fragilis and has a reported mortality of up to 25%. Computed Tomography is the most sensitive diagnostic imaging study for the detection of intraluminal or intramural gallbladder gas. Methods We report a diagnostic dilemma and multidisciplinary management of a case of emphysematous cholecystitis with unusual presentation in a young, healthy patient with no risk factors. Results A 47-year-old male chef, otherwise fit and well, presented with a clinical picture of sepsis and abdominal pain. Initial investigations were normal apart from bilateral basal atelectasis, hence he was treated for pneumonia, although without clinical improvement. Due to persistent fever, patient underwent further investigations that established the diagnosis of emphysematous cholecystitis. His clinical condition improved dramatically after urgent laparoscopic cholecystectomy with patient being safely discharged home 6 days post-op, with an uneventful postoperative recovery. Conclusion A high index of clinical suspicion and multidisciplinary team management including surgery, radiology, and microbiology is crucial for early diagnosis of the rare life-threatening condition of EC. Our clinical case highlights that EC is not limited to elderly morbid patients and urgent laparoscopic cholecystectomy is the best treatment when feasible.