A pathology requiring urgent cholecystectomy : emphysematous cholecystitis

A 57-year-old male patient was admitted to the emergency service with right upper quadrant pain that started after dinner three days ago and getting worse in the last a few hours. There was no history of chronic disease. On physical examination, Murphy's sign was positive. Labarotory parameters except for leucocyte count (19450/mm3) and C-Reactive protein (4.8 mg/dL) were within normal limits. Abdominal ultrasonography (USG) showed cholelithiasis. Contrasted enhanced computed tomography (CT) which was applied due to presence of Murphy's sign and leukocytosis revealed free air and gallstones in the gallbladder (Fig. 1). With a diagnosis of emphysematous cholecystitis (EC), urgent laparoscopic cholecystectomy was planned. Patient underwent cholecystectomy after conversion to open procedure due to advanced adhesions. In intraoperative examination, anatomy of cystic duct was unclear. Therefore, fundus of gallbladder was opened, purulent bile was drained and stones were extirpated to reveal anatomy of cystic duct (Fig. 2). Histopathological examination revealed gallbladder with fibrinopurulent exudate and hemorrhagic mucosa. Patient was discharged on post operative day 4 with healing. He had remained 5-months follow-up with no complication.