Current issue
Archive
Manuscripts accepted
About the journal
Editorial board
Abstracting and indexing
Contact
Instructions for authors
Ethical standards and procedures
Editorial System
Submit your Manuscript
|
2019
vol. 84 Gastrointestinal and abdominal radiology
abstract:
Case report
A deceptive case of emphysematous cholecystitis complicated with retroperitoneal gangrene and emphysematous pancreatitis: clinical and computed tomography features
Małgorzata Deręgowska-Cylke
,
Piotr Palczewski
,
Marek Pacholczyk
,
Maurycy Jonas
,
Radosław Cylke
,
Maciej Kosieradzki
,
Marek Gołębiowski
© Pol J Radiol 2019; 84: e41-e45
Online publish date: 2019/01/16
View full text
Get citation
ENW EndNote
BIB JabRef, Mendeley
RIS Papers, Reference Manager, RefWorks, Zotero
AMA
APA
Chicago
Harvard
MLA
Vancouver
Purpose
Emphysematous cholecystitis (EC) is an uncommon, severe variant of acute cholecystitis caused by gas- forming bacteria – most often Clostridium perfringens and Escherichia coli. We present a deceptive case of EC associated with retroperitoneal gas gangrene and emphysematous pancreatitis. Case report An 86-year-old, overweight woman was admitted to the emergency department with non-specific abdominal symptoms. Admission laboratory tests showed elevated diastase levels indicating acute pancreatitis. Computed tomography (CT) demonstrated a substantial amount of gas in the retroperitoneum and peritoneal cavity, which raised a suspicion of duodenal perforation. Primary diagnosis was not confirmed during emergency laparotomy, which revealed a gangrenous gallbladder adjacent to the duodenum and surrounded by purulent fluid. The final diagnosis established after laparotomy and rereading of CT scans was that of emphysematous cholecystitis associated with gangrenous pancreatitis and retroperitoneal gangrene. After surgery, the patient was transferred to the intensive care unit in septic shock. Shortly after, the second laparotomy was undertaken on suspicion of internal bleeding. During surgery, the patient experienced cardiac arrest and died despite immediate resuscitation. Conclusions Emphysematous cholecystitis may be associated with a spread of infection both to the peritoneal cavity and retroperitoneum and result in a substantial amount of gas in those anatomic compartments. The knowledge of this rare complication may be helpful in establishing a correct diagnosis. keywords:
pancreatitis, pneumoperitoneum, multidetector computed tomography, emphysematous cholecystitis, fasciitis, necrotising |