Gas Gangrene of the Gallbladder
An 84-year-old man presented with right-sided upper abdominal pain and fulminant sepsis. The wall of the gallbladder could not be differentiated on sonography, and computed tomography revealed emphysematous cholecystitis with pneumatosis of the gallbladder wall (Figure, yellow arrows) and aerobilia of the bile ducts (not shown). Sepsis treatment by means of fluid replacement and antibiosis with piperacillin/tazobactam were accompanied by immediate laparoscopic cholecystectomy. A massive amount of Clostridium perfringens was demonstrated in the gallbladder aspirate. The toxic clinical picture with pneumatosis of the gallbladder corresponds to gas gangrene of the gallbladder. This life-threatening situation must be distinguished from the frequently encountered microbiological detection of C. perfringens in the gallbladder without related clinical symptoms. The treatment described above led to rapid recovery.
Dr. med. Benjamin Sommer, Prof. Dr. med. Stefan Eggstein, HELIOS Klinik Titisee-Neustadt, Allgemein- und Viszeralchirurgie, email@example.com
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by David Roseveare.
Cite this as: Sommer B, Eggstein S: Gas gangrene of the gallbladder. Dtsch Arztebl Int 2020; 117: 38. DOI: 10.3238/arztebl.2020.0038