Deręgowska-Cylke Małgorzata, Palczewski Piotr, Pacholczyk Marek, Jonas Maurycy, Cylke Radosław, Kosieradzki Maciej, Gołębiowski Marek
1 Department of Clinical Radiology, Medical University of Warsaw, Poland.
Department of General and Transplantation Surgery, Medical University of Warsaw, Poland.
Pol J Radiol. 2019 Jan 16;84:e41-e45. doi: 10.5114/pjr.2019.82858. eCollection 2019.
Emphysematous cholecystitis (EC) is an uncommon, severe variant of acute cholecystitis caused by gas- forming bacteria - most often and . We present a deceptive case of EC associated with retroperitoneal gas gangrene and emphysematous pancreatitis.
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.
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.
气肿性胆囊炎（EC）是一种由产气细菌引起的罕见的急性胆囊炎严重变体，最常见的产气细菌是[此处原文缺失产气细菌名称]。我们报告一例伴有腹膜后气性坏疽和气肿性胰腺炎的具有迷惑性的气肿性胆囊炎病例。
一名86岁超重女性因非特异性腹部症状被收入急诊科。入院实验室检查显示淀粉酶水平升高，提示急性胰腺炎。计算机断层扫描（CT）显示腹膜后和腹腔内有大量气体，这引发了十二指肠穿孔的怀疑。急诊剖腹手术未确诊，术中发现十二指肠旁有坏疽性胆囊，周围有脓性液体。剖腹手术后及再次阅读CT扫描结果后最终确诊为气肿性胆囊炎合并坏疽性胰腺炎和腹膜后坏疽。术后，患者因感染性休克被转入重症监护病房。不久后，因怀疑内出血进行了第二次剖腹手术。手术过程中，患者心脏骤停，尽管立即进行了复苏仍死亡。
气肿性胆囊炎可能伴有感染扩散至腹腔和腹膜后，并在这些解剖区域产生大量气体。了解这种罕见并发症可能有助于做出正确诊断。
