[A patient with acute abdominal pain and known cardiovascular disease].

BACKGROUND: Emphysematous cholecystitis (EC) is a serious variant of acute cholecystitis (AC), with gas-forming bacteria in the biliary system and the surrounding tissues. The pathogenesis of EC is assumed to be ischemia. EC is associated with diabetes mellitus and arteriosclerosis; has a higher mortality rate and a more rapid progression than AC, but has initial clinical findings, similar to those in AC-patients.

METHOD: We present a case report describing a patient with cardiovascular disease and sepsis, who has acalcular emphysematous cholecystitis. The patient was treated with antibiotics and percutaneus drainage. We performed a PubMed search for "Cholecystitis, Emphysematous, Acalcular". The literature study describes case reports and retrospective analyses.

INTERPRETATION: EC arises in 1-3% of AC, with a mortality rate of 15%, compared to 4% in AC. EC has a 30-fold risk of necrosis and a 5-fold risk of perforation of the gall bladder wall compared to AC. Ultrasound imaging may be difficult to interpret and CT scanning is the preferred method of diagnosis. Recommended treatment is immediate cholecystectomy in association with antibiotics directed against the most common infectors, Cl. perfringens and enteropathogenic bacteria. Open and laparoscopic procedures seem equal in outcome. Some reports, as the present, describe successful treatment with percutaneous drainage when necrosis-mediated perforation is absent.