Emphysematous cholecystitis successfully treated by laparoscopic surgery
A 78-year-old male was admitted to our hospital for an investigation of vertigo. He had past medical history of diabetes mellitus, hypertension and dyslipidemia. After admission, he developed fever and abdominal distention. A chest X-ray in the up-right position and abdominal computed tomography (CT) were performed. The chest X-ray showed the presence of gas within the gallbladder and in its wall (Fig. ). The CT scan revealed emphysematous changes in the gallbladder wall and air within the gallbladder (Fig. A and B). Therefore, a diagnosis of EC was made. The patient was referred to the Department of Surgery and emergent surgery was performed.\nBased on the hemodynamically stable status of the patient, we selected a laparoscopic approach. Exploration of the abdominal cavity revealed gangrene and necrosis of the gallbladder. To facilitate the resection, we initially punctured the gallbladder using a percutaneous needle to extract bile. Ascites surrounding the gallbladder suggested perforation. Although there was significant adhesion, we were able to safely dissect the Calot's triangle and detected a cystic duct and artery. Gallbladder resection was successfully completed without conversion to open laparotomy. His postoperative course was uneventful. A bile culture obtained during surgery revealed Clostridium perfringens, Enterobacter cloacae and Enterococcus faecalis as the causative organisms.