A CASE OF EMPHYSEMATOUS CHOLECYSTITIS WITH PNEUMOBILIA

A 73-year-old woman was admitted to the hospital because of tenderness in the right upper quadrant and a positive Murphy's sign. Her past history revealed hypertension, atrial fibrillation and sick sinus syndrome. Blood studies showed an evidence of severe inflammatory response without jaundice or liver injury. Abdominal pain film and CT scan showed gas in the gallbladder and intrahepatic bile duct. With a diagnosis of acute emphysematous cholecystitis, percutaneous transhepatic gallbladder drainage (PTGBD) was performed, but emergency laparotomy was not done so that the patient's heart disease could be evaluated preoperatively. Cholecystectomy and choledochotomy were performed 12 days after admission. Three black stones 2mm in size were present in the gallbladder, and histological examination of the gallbladder showed necrosis. The postoperative course was uneventful, and the patient was discharged 34 days after the operation. We present a very rare case of emphysematous cholecystitis associated with pneumobilia, together with a review of 14 cases of this disease in the Japanese literature, including our own case. Whether air is present or not in the bile duct, it has a good prognosis if appropriate surgical treatment is performed immediately.