Emphysematous cholecystitis presenting as gas-forming liver abscess and pneumoperitoneum in a dialysis patient: a case report and review of the literature

A case of amoebic liver abscess and emphysematous gallbladder in a 65-year-old male with situs inversus totalis

INTRODUCTION AND IMPORTANCE

Situs inversus totalis, a rare congenital condition, is characterized by the mirror-image reversal of the abdominal and thoracic organs. Amoebic liver abscess and emphysematous gallbladder are severe gastrointestinal infections. The coexistence of these three conditions is extremely rare.

CASE PRESENTATION

We present the case of a 65-year-old male who presented with abdominal pain, fever, and jaundice. Investigations revealed situs inversus totalis, amoebic liver abscess, and emphysematous gallbladder. The patient underwent successful treatment with antibiotics and open surgery drainage of the liver abscess, and subtotal cholecystectomy.

CLINICAL DISCUSSION

The co-occurrence of situs inversus totalis, amoebic liver abscess, and emphysematous gallbladder poses a diagnostic challenge and requires thorough evaluation and appropriate management.

CONCLUSION

Situs inversus totalis may coincide with other conditions like amebic abscess and emphysematous gallbladder, complicating diagnosis and treatment. Early diagnosis and prompt intervention are crucial to improve outcomes.

Managing silent threats: Unveiling gangrenous complication in acute emphysematous cholecystitis

Emphysematous cholecystitis is a potentially life-threatening variant of acute cholecystitis, characterized by the presence of gas in the gallbladder wall/lumen due to the proliferation of gas-producing bacteria. Symptoms include upper right quadrant pain, fever, nausea, and vomiting. Laboratory tests may show nonspecific indications of systemic infection, and radiological assessment, especially CT scanning, is crucial for diagnosis. This case underscores the significance of early diagnosis and intervention in managing emphysematous cholecystitis to prevent serious complications and reduce the higher mortality rate compared to acute cholecystitis.

Emphysematous cholecystitis: A deadly disguise of a common culprit

Emphysematous cholecystitis is a critical differential diagnosis for physicians to consider when evaluating patients with acute abdomen. Patients who are unable to undergo emergency surgery can benefit from percutaneous cholecystostomy.

Successful treatment of emphysematous cholecystitis by laparoscopic surgery

Emphysematous cholecystitis (EC) is a severe and rare variant of acute cholecystitis characterized by ischemia of the gallbladder wall with gas-forming bacterial proliferation. Open cholecystectomy is traditionally the gold standard approach to treatment due to difficulty in isolating Calot’s triangle in the setting of intense inflammation. We present a case of EC successfully and safely treated by laparoscopic surgery.

Emphysematous cholecystitis during the treatment of heat stroke

Background

During a heat stroke, microvascular injury may occur as a result of thermal damage and systemic hypoperfusion. We present a case of an older woman who experienced emphysematous cholecystitis during a treatment of heat stroke.

Case presentation

A 91-year-old woman presented unconscious with a blood pressure, pulse, and core temperature of 73/48 mmHg, 135 bpm, and 39.8°C, respectively. The patient was diagnosed with heat stroke. Twenty-two hours after arrival, the patient fell into septic shock. We diagnosed emphysematous cholecystitis and performed an emergency cholecystectomy. As the bile culture was positive for Clostridium perfringens, meropenem was administered. The patient was transferred for rehabilitation 32 days after admission.

Conclusions

Emphysematous cholecystitis can present during a treatment of heat stroke. An abdominal X-ray examination should be performed during treatment of heat stroke in the acute phase regardless of the physical assessment.

Spontaneous Hepatic Hemorrhage Caused by Emphysematous Cholecystitis: A Case Report and Literature Review

BACKGROUND

Emphysematous cholecystitis and spontaneous hepatic hemorrhage are uncommon and serious conditions with non-specific presentations that can lead to a poor clinical outcome. We report a case of spontaneous hepatic hemorrhage of emphysematous cholecystitis. A 49-year-old male presented to the emergency department with fever, chills, right upper quadrant pain, vomiting, and diarrhea of four days' duration. He had a history of diabetes mellitus, hypertension, and uarthritis. Computed tomography (CT) revealed an enlarged gallbladder with intra-luminal, intra-mural, and peri-cholecystic air; subcapsular high-density fluid collection; and an intra-hepatic mass with gas and liquid in the right lobe of the liver. After receiving prompt administration of appropriate antibiotic agents, drainage, and an alternative operation the patient recovered well.

CONCLUSION

Emphysematous cholecystitis is potentially fatal because of its serious complications. It needs to be diagnosed promptly, not only based on the effervescent gallbladder sign but also on the inflammatory presentations. Furthermore, for patients with spontaneous hepatic hemorrhage, attention should be paid to the underlying cause. Treatment should be individualized to improve diagnosis and cure as early as possible, thereby improving prognosis.

Progress in clinical research complicated infection with diabetes mellitus

Patients with diabetes are prone to concurrent infection. The mechanism of concurrent infection is related to factors such as hyperglycemia and weakened defense function. The infections of patients with diabetes include general and special infections. General infection includes infections in the respiratory system, urinary system, hepatobiliary system, and skin mucosa. Meanwhile, special infection includes invasive otitis externa, nasal mucormycosis, necrotizing fasciitis, and emphysema infection. Patients with special infections also have a higher mortality rate than those with general ones. Complicated infection with diabetes is difficult to treat and has poor prognosis. Therefore, a patient requires active treatment once infected with this infection.

Metastatic Gallbladder Melanoma Presenting as Acute Emphysematous Cholecystitis

Malignant melanoma is an aggressive tumor with a high potential for distant metastases, including spread to the gallbladder where it represents more than half of all metastases detected at autopsy. Yet, it is rarely symptomatic in life and is a rare cause of acute cholecystitis. Emphysematous cholecystitis is a rare, potentially fatal variant of acute cholecystitis characterized by the presence of gas in the gallbladder lumen or wall. We report a 77-year-old woman with acute emphysematous cholecystitis as the initial feature of recurrent melanoma metastatic to the gallbladder. This exceptional association highlights the need to consider a relapse of malignancy when assessing unexplained abdominal symptoms in any patient with a prior history of melanoma.

Post-ERCP Emphysematous Cholecystitis in a Young Woman: A Rare and Potentially Fatal Complication

A 45-year-old woman with suspected Functional Biliary Sphincter Disorder (FBSD) developed Clostridium perfringens related emphysematous cholecystitis after ERCP. A low index of suspicion for emphysematous cholecystitis in this young, otherwise healthy woman led to a significant delay in making the correct diagnosis, and air in the gallbladder was wrongly attributed to a possible gallbladder perforation. ERCP is associated with significant risks, particularly in patients with FBSD, where diagnostic uncertainty renders the balance of risk versus benefit even more critical. Post-ERCP emphysematous cholecystitis secondary to Clostridium perfringens is a rare but potentially fatal complication.

Emphysematous cholecystitis in a young male without predisposing factors: A case report

This report describes the diagnosis and treatment for Emphysematous cholecystitis (EC) without predisposing factors, and reviews the current literature.A 49-year-old male without predisposition presented to emergency department with a two-day history of sudden onset abdominal pain, hypertension and received empirical antibiotics with Imipenem/Cilastatin 0.5 g via intravenous route every 8 hours. Computed tomography (CT)-scan revealed that air encircling gallbladder is the most important and accurate evidence for EC diagnosis.Laparoscopic cholecystectomy was performed, and no stone was seen in gallbladder.The patient's temperature and pulses returned to normal following laparoscopic cholecystectomy. The festering bile culture report showed E.coli and pathological analysis of the resected gallbladder disclosed that necrosis and mild mucosal dysphasia. The patient fully recovered without complication at outpatient clinic visit three months later.The EC is an acute infection of the gallbladder wall caused by gas-forming organisms, is a life-threatening cholecystitis with mortality rate as high as 25%. Therefore, the combination of laparoscopic cholecystectomy and antibiotics is recommended as soon as possible once the diagnosis of EC was a clean-cut.