Emphysematous Cholecystitis

Emphysematous cholecystitis-

Begin with – acute cholecystitis (calculous or acalculous)

Followed by

  1. Ischemia or gangrene of the gallbladder wall
  2. Infection by gas-producing organisms.

Bacteria most frequently cultured

Most frequently cultured Bacteria –

Anaerobes- Clostridium welchii or C. perfringens

Aerobes – E. coli.

Risk Factors

Most frequently in elderly men and in patients with diabetes mellitus.


During an ultrasonogram- air in the wall or lumen of the gallbladder can interfere with the clear visualization of the gallbladder

Best imaging modality to confirm the presence of emphysematous cholecystitis

The best imaging modality to confirm the presence of emphysematous cholecystitis is a contrast-enhanced abdominal CT scan.

The plain x-ray may reveal air and/or air-fluid levels in the gallbladder.

Plain abdominal film by finding gas within the gallbladder lumen, dissecting within the gallbladder wall to form a gaseous ring, or in the pericholecystic tissues.

Morbidity and Mortality rates


Emphysematous cholecystitis shows a higher degree of endarteritis obliterans when compared to acute cholecystitis.

The causative organisms are E coli, Aerobactor aerogens, Klebsiella spp, and Salmonella spp.

Gangrene and perforation and pericholecystic abscess may ensue

The morbidity and mortality rates with emphysematous cholecystitis are High

Emphysematous cholecystitis occurs in about 1% of all cases of acute cholecystitis.

Characteristic feature

Characteristic feature of this sinister variant of cholecystitis is the presence of gas in the lumen and wall of the gallbladder

Classification according to radiological findings as progressive stages

Early stage – Air limited to the gallbladder lumen

Most advanced stage – Air in the gallbladder and the pericholecystic tissue


Prompt surgical intervention and appropriate antibiotics

Micro-organisms that have been isolated in patients with emphysematous cholecystitis include the following:

  1. Clostridia
  2. Klebsiella
  3. Escherichia coli
  4. Enterococci
  5. Anaerobic streptococci

Emphysematous cholecystitis with local perforation

Case courtesy of Chris O’Donnell, Radiopaedia.org. From the case rID: 20518

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