Ring around the gallbladder

AI Summary

An elderly woman with a history of diabetes and hypertension was diagnosed with emphysematous cholecystitis, a rare form of acute gallbladder inflammation involving gas-forming bacterial infection. This condition carries a high risk of necrosis, perforation, sepsis, and mortality, typically identified by symptoms such as pain, fever, and confirmed via abdominal CT imaging.

A woman in her 80s presented with a two day history of constant right upper quadrant pain and fever. She had a history of diabetes mellitus and hypertension.On physical examination, there was tenderness and involuntary guarding in the right upper quadrant, and Murphy’s sign was positive.Laboratory results showed a raised white cell count of 17.4×109/L (reference range 3.5–9.5×109/L) and C reactive protein concentration (293 mg/L: reference range 0–6 mg/L). Liver function tests were normal.Abdominal computed tomography showed a circumferential rim of gas surrounding an inflamed gallbladder (fig 1, arrows), and multiple free gas collections within the abdominal cavity.bmj;394/jul09_3/e087454/F1F1f1Fig 1A diagnosis of emphysematous cholecystitis was made.Emphysematous cholecystitis is an uncommon form of acute cholecystitis, associated with gallbladder necrosis, perforation, sepsis, and a high mortality rate.1 It is caused by gas forming bacteria (notably Clostridium species and Escherichia coli).2 Risk factors include advanced age and diabetes mellitus.1Abdominal computed tomography is the most...