Perforated emphysematous cholecystitis with secondary peritonitis
Presentation
Three days history of severe right upper abdominal pain with fever and generalized abdominal tenderness. No history of diabetes Mellitus.
Patient Data
The gallbladder is relatively distended with intramural gas and intraluminal air-fluid level. Areas of gallbladder wall defects involving mainly the fundus with extraluminal gas in continuity with an intraperitoneal subdiaphragmatic air-fluid collection. Extensive fat stranding around the gallbladder with thickening and enhancement of the peritoneal reflections. Adjacent inflammatory thickening of the hepatic flexure. Small adjacent hepatic abscesses are noted in segments 4 and 5 well-visualized on post-contrast axial and coronal reformatted images.
Two simple hepatic cysts are noted in the segments, 4 (54 x 24 mm) and 8 (12 x 8 mm), known (discovered a few years ago).
Small right pleural effusion is noted.
Case Discussion
CT features of perforated emphysematous cholecystitis with surrounding fat stranding, intraperitoneal subdiaphragmatic air-fluid collection and thickening with enhancement of the peritoneal reflections indicating secondary peritonitis.
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