Acute emphysematous cholecystitis with initial normal radiological evaluation: a fatal diagnostic pitfall in the ED

Abstract Acute emphysematous cholecystitis is a relatively rare disease, a severe variant of acute cholecystitis, that predominantly affects elderly diabetic men. The apparently high mortality and morbidity associated with acute emphysematous cholecystitis have previously emphasized the importance o...

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Published in:The American journal of emergency medicine 2007-05, Vol.25 (4), p.488.e3-488.e5
Main Authors: Seow, Vei-Ken, MD, Lin, Chiu-Mei, PhD, MD, Wang, Tzong-Luen, PhD, MD, Chong, Chee-Fah, MS, MD, Lin, I-Yin, MD
Format: Article
Language:English
Subjects:
Abdomen
Aged
Blood pressure
Blood tests
Cholecystectomy
Computed tomography
Diagnostic Errors
Emergency
Emergency medical care
Emergency Service, Hospital
Emphysematous Cholecystitis - diagnostic imaging
Emphysematous Cholecystitis - surgery
Female
Gallbladder
Gallbladder diseases
Gangrene
Humans
Mortality
Radiography
Rare diseases
Tomography
Treatment Outcome
Ulcers
Ultrasonic imaging
Ultrasonography
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Summary:Abstract Acute emphysematous cholecystitis is a relatively rare disease, a severe variant of acute cholecystitis, that predominantly affects elderly diabetic men. The apparently high mortality and morbidity associated with acute emphysematous cholecystitis have previously emphasized the importance of prompt diagnosis and emergent surgical intervention. Radiological evaluation including plain plain abdominal radiograph (KUB), abdominal sonography, and computed tomography of abdomen is the cornerstone of diagnosis of acute emphysematous cholecystitis. We describe a nondiabetic woman who developed sepsis due to acute emphysematous cholecystitis with rapid deterioration within 24 hours. She was misdiagnosed as having peptic ulcer disease initially due to normal KUB, abdominal sonography, and computed tomography of abdomen.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2006.11.023