CT of a 68-year-old diabetic man with fever and severe right upper quadrant pain shows gas within the wall of the gallbladder, extending as a ring of non-dependent lucencies, along with mural irregularity and mucosal sloughing. Which of the following statements about this condition is CORRECT?
- A It is most commonly caused by Clostridium welchii infection in diabetics ✓
- B It carries a lower mortality than uncomplicated acute cholecystitis
- C Gas centred in the porta hepatis favours emphysematous cholecystitis over pneumobilia
- D Ultrasound reliably excludes the diagnosis when the wall appears normal
Correct answer: A. It is most commonly caused by Clostridium welchii infection in diabetics
Explanation
Emphysematous cholecystitis is a surgical emergency caused by gas-forming organisms such as Clostridium welchii, E. coli and Klebsiella, and it occurs disproportionately in elderly men and diabetics without gallstones. Mortality exceeds that of ordinary acute cholecystitis. Gas in emphysematous cholecystitis lies in a non-dependent ring within the wall, whereas pneumobilia is gas centred toward the porta hepatis within ducts. Ultrasound may miss intramural gas, so CT is the definitive test.
Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.
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