Emphysematous cholecystitis is uncommon and life threatening form of acute cholecystitis. It is also sometimes a complication of severe or untreated acute cholecystitis. It is a surgically emergency  requiring urgent cholecystectomy or cholecystostomy due to a high risk of gallbladder gangrene and / or perforation.

In this case, the acute surgical team were made aware of the findings immediately after the scan. The patient was too unwell with a long list of comorbities for general anesthesia and cholecystectomy and hence went onto to have a US guided cholecystostomy. Bile culture was positive for Klebsiella and Enterobacter species.