Emphysematous Cholecystitis

A 70-year-old man with a history of heart disease, hyperlipidemia, and diabetes mellitus presented at the hospital with a 4-day history of increasing abdominal pain, nausea, and vomiting. The temperature was 38°C, and examination of the abdomen showed mild tenderness in the right upper quadrant. The white-cell count, including the differential count, showed leukocytosis associated with a left shift. Computed tomography of the abdomen showed multiple small gallstones, pericholecystic fat stranding, an air–liquid level within the gallbladder lumen, and gas dissecting along the entirety of the gallbladder wall — findings consistent with emphysematous cholecystitis. The patient underwent an emergency laparotomy with cholecystectomy. The gallbladder was gangrenous and emphysematous. The patient was treated with broad-spectrum antimicrobial agents and had an uneventful recovery. The culture of a gallbladder-tissue specimen showed Clostridium perfringens, which is known to be a gas-forming organism. Patients with diabetes mellitus may present with advanced infection and a paucity of symptoms.