Gallbladder Pneumatosis With Pneumoperitoneum Caused by Clostridium perfringens: A Case Report.

Emphysematous cholecystitis (EC) is a rare, life-threatening variant of acute cholecystitis characterised by gas formation within the lumen and walls of the gallbladder. This reflective case report describes a rare presentation of EC complicated by pneumoperitoneum, without free bile or identifiable perforation. It highlights the diagnostic challenges and the management considerations associated with this severe condition. A 64-year-old male with type 2 diabetes mellitus, hypertension, obesity and other comorbidities presented with a six-day history of abdominal pain and bloating. Blood tests revealed marked leukocytosis with neutrophilia and an elevated C-reactive protein. Despite an unremarkable abdominal exam, CT imaging revealed gas within the gallbladder lumen, walls and free intraperitoneal air, without associated free fluid or bile. Emergency laparoscopic cholecystectomy revealed a necrotic, gas-containing gallbladder and localised pus, but no perforation. The patient recovered well with targeted antibiotic therapy. This case highlights that pneumoperitoneum in the absence of free bile or visible perforation can occur in EC. Awareness of this atypical presentation is critical to avoid diagnostic delay and ensure timely surgical management.