Introduction:
Emphysematous cholecystitis is a serious form of acute cholecystitis (gallbladder swelling that occurs rapidly), which presents as the gas build-up in the gallbladder's walls and is life-threatening. It causes symptoms like pain in the upper right region above the abdomen, nausea, vomiting, and fever. First, a few laboratory studies like the complete blood count, liver function tests, and imaging studies like x-ray abdomen, CT (computerized tomography), ultrasound abdomen, and MRI (magnetic resonance imaging) are done to find the condition. Then, it is treated by laparoscopic cholecystectomy or percutaneous cholecystostomy.
What Is Emphysematous Cholecystitis?
Emphysematous cholecystitis damages the gallbladder's walls through gas-forming bacteria like Clostridium perfringens. It causes fatal conditions and is considered a surgical emergency.
Emphysematous is air or gas in the gallbladder, and cholecystitis is gallbladder inflammation. The gallbladder inflammation resulting from gas or air formed in the lumen (a channel inside a tube-like structure like the blood vessel) of the gallbladder is called emphysematous cholecystitis.
What Causes Emphysematous Cholecystitis?
- Blood Vessel Occlusion: Cystic artery is a blood vessel that supplies the gallbladder. A block or narrowing of the cystic artery due to atherosclerosis (plaque formation in the blood vessel) can lead to emphysematous cholecystitis.
- Infection: Bacterial organisms like Clostridium perfringens and Escherichia coli (E.coli) are responsible for gas formation in the gallbladder's walls. Other bacterial organisms like Proteus vulgaris, Aerobacter aerogenes, Staphylococcus, Streptococcus, Klebsiella, and Bacteroides fragilis also play a role in gas formation. The bacterias Clostridium perfringens (gram-positive bacteria) and Escherichia coli (E.coli, a gram-negative bacteria) are normally present in the gastrointestinal tract.
When there is a reduced or no blood supply (ischemia) to the gallbladder due to a block in the cystic artery, these bacteria migrate from the intestine to the biliary tract (which consists of the gallbladder and the bile duct). These bacterias multiply rapidly when there is low oxygen concentration and produce gas during this process. This results in the accumulation of gas in the walls of the blood vessels leading to inflammation of the gallbladder. In turn, this causes cell death due to blood supply loss or rapid bacterial growth(gangrene).
What Are the Symptoms of Emphysematous Cholecystitis?
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Low-grade fever.
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Pain in the right upper region above the stomach.
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Generalized stomach pain.
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Nausea and vomiting.
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Pain while touching the belly region.
What Tests Are Used to Find Emphysematous Cholecystitis?
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Complete Blood Count: The complete blood count screens blood parameters like the red blood cells, white blood cells, platelets, hemoglobin, eosinophils, basophils, and neutrophils to check for their normal values. If there is a variation in the normal ranges, it denotes an infection.
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Liver Function Tests: Liver function tests are used to screen the liver enzymes like alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT). The proteins like albumin, globulin, and fibrinogen are also screened to check for changes in the normal values.
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Serum Glucose: A blood test measuring the amount of glucose (blood sugar) in the blood.
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X-Ray Abdomen: It uses high-frequency radio waves to capture pictures of the bony structures and surrounding tissues.
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Ultrasound Abdomen: In ultrasound, sound waves are used to obtain images of the internal organs and their neighboring structures.
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Computed Tomography (CT) Scan Abdomen: Computed tomography uses high-frequency radio waves to get pictures of the internal organs at different angles on a computer. It gives a detailed view of the organs, neighboring tissues, and bony structures.
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Magnetic Resonance Imaging (MRI): Magnetic resonance imaging (MRI) of the abdomen uses high-frequency radio waves in a magnetic field to take pictures of the targeted organ. It shows if there are abnormalities in the targeted organ.
What Are the Treatment Procedures to Treat Emphysematous Cholecystitis?
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Medications: Broad Spectrum intravenous antibiotics like Ampicillin, Tazobactam, and Metronidazole are recommended. The medicines are continued until the patient's condition is improvised.
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Fluid Therapy: Normal saline and ringer lactate solutions balance the fluid and electrolyte and stabilize the patient.
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Hyperbaric Oxygen Therapy: It is a medical treatment that involves increasing the oxygen levels in the blood. It is done by placing an oxygen mask over the patient's face. Though this is a temporary means of oxygen supply, this induces normal oxygen levels in the tissues.
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Laparoscopic Cholecystectomy: It is a minimally invasive procedure performed to remove the gallbladder. This procedure is carried out by making four holes in the abdomen, through which a flimsy tube-like substance with a light and a camera are inserted into the stomach to view the internal part. The tools required to remove the gallbladder are also inserted into the holes to pull out the gallbladder.
What Are the Complications of Emphysematous Cholecystitis?
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Septic Shock: It is a life-threatening condition resulting from a sudden drop in blood pressure due to an infection.
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Gangrenous Cholecystitis: Cell death in the gallbladder's walls due to decreased or no blood supply.
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Gallbladder Perforation: Rupture or bursting of the gallbladder is a life-threatening condition resulting from cell death in the gallbladder.
What Is the Prevalence of Emphysematous Cholecystitis?
Emphysematous cholecystitis is prevalent in males aged 50 to 70 with an underlying condition like diabetes mellitus.
What Is the Prognosis of Emphysematous Cholecystitis?
The prognosis is moderate to poor if surgery is delayed. The mortality rate is around 15 %, and the chances of gallbladder perforations are five times higher than typical cholecystitis.
Conclusion:
Emphysematous cholecystitis is a rare but life-threatening condition caused by bacteria like Escherichia coli and Clostridium perfringens. It produces gas during rapid proliferation in the blood vessel walls where there is reduced or no blood supply. This leads to the accumulation of gas in the gallbladder and cell death, resulting in inflammation and rupture of the gallbladder. They cause symptoms like pain in the right upper belly region, nausea, vomiting, and generalized stomach pain. They are diagnosed with the help of certain laboratory tests and imaging studies like ultrasound abdomen, computed tomography (CT), and magnetic resonance imaging (MRI). They are then treated with antibiotics and fluid therapy to stabilize the patient, and a less invasive surgical procedure is done to remove the gallbladder. Delaying the treatment can be fatal to the patient. However, the complication can be prevented with early detection and rapid surgical intervention, and the patient's lifespan is also increased.
