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Emphysematous Cholecystitis: An Unusual Form of Presentation
Author(s) -
BOerema W. J.,
MCwilliam R. A.
Publication year - 1970
Publication title -
australian and new zealand journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.111
H-Index - 51
eISSN - 1445-2197
pISSN - 0004-8682
DOI - 10.1111/j.1445-2197.1970.tb05602.x
Subject(s) - medicine , laparotomy , diaphragm (acoustics) , cholecystitis , cholecystectomy , presentation (obstetrics) , cholecystography , lumen (anatomy) , gallbladder , general surgery , surgery , radiology , physics , acoustics , loudspeaker
The clinical features and pathology of emphysematous cholecystitis are briefly discussed. A description follows of a case which defied correct preoperative diagnosis in virtue of the presence of gas under the diaphragm without gas in the gallbladder wall or lumen. Summary 1. Less than 150 cases of emphysematous cholecystitis have been described in the world literature. These all showed gas in the gall‐bladder wall or lumen, recognized either on X‐ray examination or at operation. 2. A case is described where the preoperative X‐ray films showed free gas under the diaphragm and nowhere else. Laparotomy was undertaken with the provisional diagnosis of perforated viscus. An acutely inflamed gall‐bladder containing gas was removed. The patient died after operation; post‐mortem examination revealed gas in the spleen, an impacted stone at the ampulla of Vater and a necrotic liver and pancreas. 3. A possible cause of pancreatitis other than one implicating the impacted stone is put forward. 4. The frequent presence of clostridia in the biliary system