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Emphysematous cholecystitis with local perforation

Case contributed by Chris O'Donnell
Diagnosis certain

Presentation

Severe right upper quadrant pain with sepsis and hypotension

Patient Data

Age: 65
Gender: Male

Too sick for oral and IV contrast - renal dysfunction due to dehydration

Gas within the wall of the gall bladder with an air/fluid level in the lumen.  Note gas has tracked beyond the wall into the subhepatic space = local perforation (arrow) with marked inflammatory change in the surrounding fat.

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