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.