Emphysematous Cholecystitis
Sondes Mhamdi and Kais Mhamdi
N Engl J Med 2019; 381:e14
DOI: 10.1056/NEJMicm1814551
An 80-year-old man with a history of hypertension presented to the emergency department with a 2-day history of abdominal pain in the right upper quadrant. The patient was febrile. On physical examination, he had abdominal tenderness in the right upper quadrant, and Murphy’s sign was positive. Laboratory studies revealed a white-cell count of 20,000 per cubic millimeter (reference range, 4000 to 10,000). The alanine aminotransferase, aspartate aminotransferase, bilirubin, and lipase levels were normal. Findings on computed tomography of the abdomen included the presence of air encircling an inflamed gallbladder, with air tracking along the wall of the superior mesenteric vein, and a diagnosis of emphysematous cholecystitis was made. Intravenous broad-spectrum antibiotic agents were initiated, and a laparoscopic cholecystectomy was performed. A gangrenous and perforated gallbladder, including two gallstones, was resected. Bile cultures grew Escherichia coli and Klebsiella pneumoniae. The patient recovered after the surgery and was treated with a 10-day course of antibiotics. At a follow-up visit 4 weeks after discharge from the hospital, he was doing well and reported no abdominal pain.
一名80岁男性患者既往有高血压病史，因右上腹疼痛2天到急诊就诊。患者发热。体格检查发现，患者右上腹压痛，Murphy征阳性。实验室检查显示，白细胞计数20,000 /ml（参考值范围，4000 to 10,000）。谷丙转氨酶、谷草转氨酶、胆红素及脂肪酶水平正常。腹部CT发现，胆囊炎症，周围有气体聚积，且沿肠系膜上静脉走行分布，遂诊断气肿性胆囊炎。开始静脉广谱抗生素治疗，并行腹腔镜下胆囊切除术。切除了气性坏疽且穿孔的胆囊，内有2个胆囊结石。胆汁培养分离到大肠杆菌和肺炎克雷白杆菌。术后患者恢复良好，接受了10天的抗生素治疗。出院4周后随访时，患者一般情况良好且没有腹痛表现。
