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Emphysematous
cholecystitis is an uncommon variant of cholecystitis, incidence of
1%. It is characterized by the presence of gas in the gallbladder wall,
presumably consequent to the invasion of the mucosa by gas-producing
organisms (e.g. E. coli,
Klebsiella sp, and Clostridium perfringens). |
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INTRODUCTION |
Emphysematous
cholecystitis is an unusual presentation of acute cholecystitis. We
report two diabetic patients treated by cholecystectomy. |
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CASE
1 |
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A
40 year old diabetic lady presented with history of pain in
right upper abdomen, fever and jaundice since 3-4 days. On examination
she has tachycardia with tenderness in the right hypochrondrium
and absent bowel sounds. Plain abdominal X-ray showed the presence
of distended gallbladder with pericholecystic fluid collection.
Computed tomography scan of the abdomen showed a distended gallbladder
with presence of gas around the gallbladder
(Fig. 1).
On exploration the posterior wall of the gallbladder was gangrenous
and sloughed out with presence of stones in the gallbladder
and presence of turbid pericholecystic fluid. A complete cholecystectomy
could be performed safely. Patient had an uneventful recovery
and was discharged on 10th postoperative day. |
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Case
2 |
A
60 year old diabetic lady presented with generalized
pain in abdomen and fever since 3 days. Patient had tachycardia with
generalized guarding and rigidity on per abdominal examination. Abdominal
X-ray showed presence of dilated small bowel loops. Ultrasound examination
showed presence of distended gallbladder with a communicating abscess
cavity in the right lobe of the liver. Computed tomography (CT) scan
of the abdomen was suggestive of an intrahepatic rupture of the gallbladder
with presence of gas in the abscess cavity and gallstones lying in the
abscess cavity. On surgical exploration, after dissection there was
evidence of an intrahepatic rupture of the gallbladder with sloughed
off wall, and presence of pus and gallstones in the abscess cavity.
Complete cholecystectomy could be performed, and the abscess cavity
was drained with portex drain 32F after a good lavage was given.
Post operatively patient had a stormy course due to diabetes and metabolic
problems. There was no evidence of a biliary fistula. The pus examination
showed the growth of E Coli, which responded well to antibiotics. |
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DISCUSSION |
Emphysematous
cholecystitis (EC) is a rare but life-threatening complication of acute
cholecystitis characterized by early gangrene and perforation of the
gallbladder, and an early diagnosis is required to prevent delay in
patient management.1 Infection is caused by gas-producing organism (C
perfringens, E coli and B fragilis). The morbidity and mortality rate
are 15%.2 The immediate treatment for this condition is cholecystectomy,
however percutaneous gallbladder drainage is reported in cases where
the general condition of the patient is not fit for surgery.3 Emphysematous
cholecystitis is also known to cause a rare complication of intrahepatic
perforation with formation of abscess. The diagnosis is based on ultrasound
and CT scan of the abdomen showing the presence of gas around the gallbladder
and if perforated intrahepatic abscess formation with gas in the cavity.
The treatment advised is emergency cholecystectomy with the intrahepatic
abscess drainage.4,5 |
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ACKNOWLEDGEMENT |
We
would like to acknowledge our Dean Madam |
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REFERENCES |
| 1. |
Garcia TL, Rodriguez JA, Fernandez S, Garcia ML. Acute Emphysematous
Cholecystitis : Report of 20 cases. Hepatogastroenterology 1999;
46 (29) : 2144-8. |
| 2. |
Madrinan
M, Fraguela J, Acea B, Taboada L. Emphysematous Cholecystitis.
Diagnosis, clinical course, and treatment. Rev Esp Enfem Dig
1999; 91 (12) : 853-6. |
| 3. |
Slot
WB, Ooms HW, Vander SD, Puylaert JB. Percutaneous gallbladder
drainage in emphysematous cholecystitis. Neth J Med 1995; 46
(2) : 86-9. |
| 4. |
Peer
A, Witz E, Manor H, Strauss S. Intrahepatic abscess due to gallbladder
perforation. Abdominal Imaging 1995; 20 (5) : 452-5. |
| 5. |
Matsura T, Kato Y, Murakami R, Watanbe M. A case of gas-containing
liver abscess associated with emphysematous change in the gallbladder.
Hiroshima J Med Sci 1995; 44 (1) : 7-11. |
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ROTAVIRUS
IN THE BLOOD-ANOTHER TURN OF THE WHEEL
Roravirus has been known in veterinary circles as an important
cause of infantile diarrhoea since the 1950s. Rotavirus persists
throughout the world as the main cause of paediatric diarrhoea.
Many infants with rotavirus are feverish and present with symptoms
of upper respiratory infection.
In the paper by Blutt and colleagues, assay of the quantity
of rotavirus antigen in stools and sera from infected children
by ELISA gave similar results.
It remains to be seen whether the finding that rotavirus may
be a systemic infection becomes important for vaccine development.
David C A Candy The Lancet 2003; 362 : 1429 |
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