Question

65 year-old diabetic patient presents with abdominal pain. What's the abnormality on Xray?

 

Answer

Emphysematous Cholecystitis

Emphysematous Cholecystitis

• More common in elderly patients, especially with diabetes
• Usually due to ischemia secondary to systemic hypoperfusion, atherosclerosis, embolism, or vasculitis
• Common organisms causing infection include Clostridium, E. Coli, Klebsiella, and anaerobic streptococci.
• Early antibiotic treatment is mandatory, but definitive surgery is typically required
• Air-fluid level and distended gallbladder may be seen on upright plain abdominal radiographs; CT scan demonstrates air in the GB wall and sometimes throughout the biliary tree

References

Carrascosa MF, et al.  Emphysematous Cholecystitis. CMAJ.10 Jan 2012; 184(1): E81