A 68-year-old diabetic man presents with high fever, right upper quadrant pain, and leukocytosis. CT abdomen shows gas within the gallbladder wall. What is the diagnosis?

• A Acute calculous cholecystitis
• B Acalculous cholecystitis
• C Porcelain gallbladder
• D Emphysematous cholecystitis ✓

Explanation

Gas within the gallbladder wall on CT is pathognomonic for emphysematous cholecystitis, a severe form caused by gas-forming organisms (Clostridium, E. coli) in diabetic patients. Porcelain gallbladder shows mural calcification, not gas. Acute calculous and acalculous cholecystitis do not demonstrate intramural gas. This condition carries high mortality and requires urgent intervention.

Reference: Sabiston Textbook of Surgery, 20th ed.

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