Emphysematous cholecystitis is a variant of
acute cholecystitis characterized by the presence of gas in the gall bladder lumen, wall or pericholecystic tissues in the absence of an abnormal communication between the biliary system and the gastrointestinal tract. In the past, the diagnosis has relied on the plain abdominal radiograph (AXR), since there are no clinical features to separate this condition from simple
acute cholecystitis. The apparently high mortality and morbidity associated with
emphysematous cholecystitis has previously emphasized the importance of emergency
cholecystectomy. We have reviewed eight cases of
emphysematous cholecystitis presenting to this hospital over the last 5 years. The diagnosis was made on AXR in only one of these cases. Ultrasound (US) scans were performed in all eight cases, of which five were positive and three negative, due to non-visualization of the gall bladder. In the three negative cases, the diagnosis was made on subsequent CT scans. On initial clinical examination, only one of the eight patients appeared systemically unwell and
conservative management was employed in five of the patients. The remaining three patients underwent
cholecystectomy within 3-5 days because of continuing signs or symptoms. It is concluded that the AXR is relatively insensitive in the diagnosis of
emphysematous cholecystitis. As a result of the regular use of US in suspected
hepatobiliary disease,
emphysematous cholecystitis is being diagnosed with increased frequency, uncovering a broad spectrum of disease ranging from mild to severe. Previously, failure to separate milder cases from simple
acute cholecystitis may have been responsible for reports of unremitting severity and progression requiring emergency
cholecystectomy. Based on clinical assessment, conservative surgical management is possible in a significant proportion of patients.