Pneumomediastinum as a complication of emphysematous cholecystitis: Case report

Abstract

BackgroundEmphysematous cholecystitis is a variant of acute cholecystitis which is generally caused by gas-forming organisms. Emphysematous cholecystitis may cause gas spreading within the subcutaneous tissue, peritoneal cavity and retroperitoneum.Case presentationWe present a case of emphysematous cholecystitis in a middle-aged diabetic patient who, postoperatively, presented edema in both flanks and left chest crepitation on palpation, associated with hemodynamic worsening. Computed tomography scan of the chest and abdomen revealed a large pneumomediastinum, pneumoretroperitoneum, gas in subcutaneous tissue and flank abscesses. In both blood and surgical wound exudate cultures, Escherichia coli was found.ConclusionEmphysematous cholecystitis should be considered as a possible cause of pneumomediastinum.

Acute Emphasematous Cholecystitis

“…DelgadoPlasencia et al concluded that should be considered as a possible cause of pneumomediastinum [8]. EC should be considered as a possible cause of soft tissue gas gangrene [9].…”

Emphysematous Cholecystitis

“…1,2 The first mentions of EC in the literature were in 1896 by Welch and Flexner. 3 Five years later, Stolz further described the presence of gas in the gallbladder after performing autopsies on three patients. 3,4 In the early 1900s, Hegner described the radiographic features of EC, while Pene postulated that perhaps instead of being a distinct pathology, EC was possibly a variant of acute cholecystitis (AC).…”

“…3 Five years later, Stolz further described the presence of gas in the gallbladder after performing autopsies on three patients. 3,4 In the early 1900s, Hegner described the radiographic features of EC, while Pene postulated that perhaps instead of being a distinct pathology, EC was possibly a variant of acute cholecystitis (AC). 1,3 Etiology Emphysematous cholecystitis, also referred to as acute gaseous cholecystitis, aerocholecystitis, clostridial cholecystitis, pneumocholecystitis, or gas gangrene of the gallbladder, has been suggested to be an uncommon outcome of acute cholecystitis, occurring in only 1% to 4% of cases.…”

“…3,4 In the early 1900s, Hegner described the radiographic features of EC, while Pene postulated that perhaps instead of being a distinct pathology, EC was possibly a variant of acute cholecystitis (AC). 1,3 Etiology Emphysematous cholecystitis, also referred to as acute gaseous cholecystitis, aerocholecystitis, clostridial cholecystitis, pneumocholecystitis, or gas gangrene of the gallbladder, has been suggested to be an uncommon outcome of acute cholecystitis, occurring in only 1% to 4% of cases. 1,3 It has been postulated that following an initial bout of acute cholecystitis, the disease progresses in a manner that results in gallbladder ischemia, with the subsequent invasion of gas-producing bacteria within the gallbladder wall.…”

“…1,3 Etiology Emphysematous cholecystitis, also referred to as acute gaseous cholecystitis, aerocholecystitis, clostridial cholecystitis, pneumocholecystitis, or gas gangrene of the gallbladder, has been suggested to be an uncommon outcome of acute cholecystitis, occurring in only 1% to 4% of cases. 1,3 It has been postulated that following an initial bout of acute cholecystitis, the disease progresses in a manner that results in gallbladder ischemia, with the subsequent invasion of gas-producing bacteria within the gallbladder wall. 1,5 Ischemia is thought to result from primary vascular compromise to the gallbladder, yielding necrosis and an environment where bacteria can proliferate.…”