Acute Abdomen with a Rare Presentation of Emphysematous Cholecystitis: A Case Study

Introduction. The acute abdomen is a common presentation in the emergency department. In the adult population acute cholecystitis is often the diagnosis but rarely presents as emphysematous cholecystitis (EC). Traditional history and physical exam assisted by modern technology frequently aids clinicians in effectively determining the etiology of abdominal pain that lead to rapid treatment. EC has increased morbidity and mortality rates that demanded aggressive surgical intervention. Case presentation. A 61- year-old hypothermic male presented to the emergency department with an acute onset of epigastric abdominal pain that progressed in intensity over several hours. Associated symptoms included nausea, non-bilious vomiting, diaphoresis, and rigors. The patient presented with an acute abdomen. Deviation From the Expected. Despite high potential morbidity and mortality rates, aggressive surgical and intensive care pre and post-operative management led to a brief hospitalization and early discharge. Discussion. This patient presented with the risk factors for EC that were confirmed by pathology. Labs suggested and imaging techniques verified the diagnosis pre-operatively. Immediate medical therapy involved pain control, the rapid infusion of intravenous fluid replacement, and broad-spectrum IV antibiotics. The various surgical treatment options discussed included open versus closed laparoscopic surgery or gallbladder drainage. The definitive treatment of this condition was laparotomy with open cholecystectomy. Conclusion. The usual complications of EC that include peritonitis, gangrene, sepsis, or death were avoided in this case by aggressive surgical management. Clinicians in an acute setting must maintain a high index of suspicion for EC in the adult patients that present with an acute abdomen.