Emphysematous cholecystitis is an acute infection of the gallbladder caused by gas-forming organisms
Several factors can account for an emphysematous cholecystitis
In most of the patients with an emphysematous cholecystitis gallstones are found, often with obstruction of the cystic duct. However an emphysematous cholecystitis can also be found in cases of an acalculous cholecystitis
An emphysematous cholecystitis is more common in elderly patients with atherosclerosis. Diabetes is not uncommon. Although gallstones are more common in females, an emphysematous cholecystitis is more frequently found in males
Infection with gas-forming organisms
In about 1/3 of the cases clostridium perfringens is found. Other organisms are E. Coli and Klelbsiella
The mortality rate of an emphysematous cholecystitis is much higher than in cases of a non emphysematous cholecystitis.
Because of gallbladder wall ischemia there is a high risk of perforation of the wall. In this case an abscess has formed in the omental bursa.
The ultrasound findings of an emphysematous cholecystitis are.
Highly reflective air in the wall or the lumen of the gallbladder
Air in the wall must be differentiated from calcium which can be found in a porcelain gallbladder. If in doubt X ray can help differentiating between the two
An ill defined wall is not uncommon.
Thickened bile and or stones are a frequent findings
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