DOI: http://dx.doi.org/10.18203/2349-2902.isj20210354

Current experience with emphysematous cholecystitis

Ramiz Iqbal, Elvina Wiadji

Abstract


Background: Emphysematous cholecystitis (EC) is a rare variant of acute cholecystitis with a reported 15-25% mortality rate. Conventionally, EC is managed with an early open cholecystectomy. However, recent advancement in percutaneous intervention and laparoscopic techniques have influenced our management of this biliary pathology. This study reviews the management and outcomes of EC in a regional centre.

Methods: Retrospective analysis of a clinical database constituting all patients diagnosed with EC at a regional Australian hospital in NSW from Jan 2010 to July 2019. Inclusion criteria: sepsis, abdominal pain and radiological evidence of gas in the gallbladder wall, lumen, and pericholecystic tissue in the absence of an abnormal connection between the gallbladder and gastrointestinal tract. We investigated patient risk factors, management and outcomes.

Results: 16 patients with EC were identified. The mean age of the cohort was 73 years old. The majority of patients had co-morbidity including type 2 diabetes and ischemic heart disease (56 and 62% respectively). Laparoscopic cholecystectomies were performed in 9 patients during their index admissions and 7 patients were managed with PTC. 5 patients required ICU admission for septic shock, and all were managed with PTC drain placement. The overall mortality rate was 6%.

Conclusions: Laparoscopic cholecystectomy on index admission is the treatment of choice for EC. Although more technically challenging, adverse clinical event including major complication and open conversion was avoided in our cohort while percutaneous cholecystostomy was reserved for unstable and poor surgical candidate.


Keywords


Emphysematous cholecystitis, Percutaneous cholecystostomy, Laparoscopic cholecystectomy

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References


Al Mogrampi S, Verroiotou M, Fardellas I. Emphysematous cholecystitis a surgical emergency condition. Hellenic J Surg. 2013;85:424-7.

May RE, Strong R. Acute emphysematous cholecystitis. Br J Surg. 1971;58:453-8.

Bouras G, Lunca S, Vix M, Marescaux J. A case of emphysematous cholecystitis managed by laparoscopic surgery. J Soc Laparoendosc Surg. 2005;9:478-80.

Imanzadeh A, Kokabi N, Pourjabbar S, Latich I, Pollak J, Kim H, et al. Safety and Efficacy of Percutaneous Cholecystostomy for Emphysematous Cholecystitis. J Clin Imaging Sci. 2020;10:9.

Chiu HH, Chen CM, Mo LR. Emphysematous cholecystitis. Am J Surg. 2004;188:325-6.

Zippel D, Shapiro R, Goitein O, Halshtok O, Papa M. Emphysematous cholecystitis: don't be lulled into complacency. J Emerg Med. 2011;41:400-1.

Sunnapwar A, Raut A, Nagar A, Katre R. Emphysematous cholecystitis: Imaging findings in nine patients. Indian J radiol imaging. 2011;21:142-6.

Ash-Miles J, Roach H, Virjee J, Callaway M. More Than Just Stones: A Pictorial Review of Common and Less Common Gallbladder Pathologies. Curr Problems Diagnostic Radiol. 2008;37:189-202.

Wu JM, Lee CY, Wu YM. Emphysematous cholecystitis. Am J Surg. 2010;200:e53-4.

Eldar S, Sabo E, Nash E, Abrahamson J, Matter I. Laparoscopic cholecystectomy for acute cholecystitis: prospective trial. World J Surg. 1997;21:540-5.

Hazey JW, Brody FJ, Rosenblatt SM, Brodsky J, Malm J, Ponsky JL. Laparoscopic management and clinical outcome of emphysematous cholecystitis. Surg Endosc. 2001;15:1217-20.

Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg. 1995;180:101-25.

Nassar AHM, Ng HJ, Wysocki AP, Khan KS, Gil IC. Achieving the critical view of safety in the difficult laparoscopic cholecystectomy: a prospective study of predictors of failure. Surg Endoscopy. 2020;14(4):354-7.

Elshaer M, Gravante G, Thomas K, Sorge R, Al-Hamali S, Ebdewi H. Subtotal Cholecystectomy for “Difficult Gallbladders”: Systematic Review and Meta-analysis. JAMA Surg. 2015;150:159-68.

Garcia-Sancho Tellez L, Rodriguez-Montes JA, Fernandez de Lis S, Garcia-Sancho Martin L. Acute emphysematous cholecystitis. Report of twenty cases. Hepatogastroenterol. 1999;46:2144-8.

Chok KSH, Chu FSK, Cheung TT, Lam VWT, Yuen WK, Ng KKC, et al. Results of percutaneous transhepatic cholecystostomy for high surgical risk patients with acute cholecystitis. ANZ J Surg. 2010;80:280-3.