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Potentially life-threatening emergency
Emphysematous cholecystitis
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Other Resources UpToDate PubMed
Potentially life-threatening emergency

Emphysematous cholecystitis

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Contributors: Amirah Khan MD, Paritosh Prasad MD
Other Resources UpToDate PubMed

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Synopsis

Emphysematous cholecystitis : Nausea, Vomiting, Low grade fever, RUQ pain, WBC elevated
Emphysematous cholecystitis is a rare variation of acute cholecystitis caused by secondary infection of the gallbladder wall with gas-forming bacteria such as Clostridium welchii, Clostridium perfringens, Escherichia coli, and Bacteroides fragilis as well as Pseudomonas, staphylococci, and streptococci. Men between the ages of 50 and 70 are most frequently affected. Type 2 diabetes and gallstones are common in affected patients. Emphysematous cholecystitis can also arise due to ischemia from atherosclerosis of the cystic artery.

Common presenting symptoms are similar to those for acute cholecystitis and include upper right quadrant abdominal pain, nausea, vomiting, and low-grade fever. On physical exam, abdominal wall crepitus may be palpated in the area overlying the gallbladder. Common complications include gangrene, perforation, pericholecystic abscess, and peritonitis. Uncommon complications include pneumoperitoneum.

Emergent antibiotic therapy followed by cholecystectomy is the treatment of choice due to increased risk of perforation.

Codes

ICD10CM:
K81.0 – Acute cholecystitis

SNOMEDCT:
32067005 – Acute emphysematous cholecystitis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:05/20/2018
Last Updated:05/20/2018
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Potentially life-threatening emergency
Emphysematous cholecystitis
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A medical illustration showing key findings of Emphysematous cholecystitis : Nausea, Vomiting, Low grade fever, RUQ pain, WBC elevated
Imaging Studies image of Emphysematous cholecystitis - imageId=8355357. Click to open in gallery. caption: '<span>Image from CT scan demonstrates a distended gallbladder with air in the wall. The patient also had gallstones. </span>'
Image from CT scan demonstrates a distended gallbladder with air in the wall. The patient also had gallstones.

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