Insidious Presentation of Emphysematous Cholecystitis in A Type 2 Diabetic Man

We present the clinical course of a 77-year-old diabetic man with jaundice and nausea for one week. An abdominal ultrasound examination revealed a hyperechoic gallbladder wall and a normal common bile duct. Computed tomography disclosed air in the gallbladder lumen as well as intramural air; these are consistent with emphysematous cholecystitis. He was treated with antibiotics and percutaneous gallbladder drainage and finally was discharged uneventfully. We discuss the unusual insidious presentation of emphysematous cholecystitis in this patient, together with the pitfalls related to imaging studies of emphysematous cholecystitis as compared with gallbladder adenomyomatosis. Computed tomography should be considered early when examining diabetic patients who have acoustic artifacts and reverberation shadows on ultrasonography when this is linked to abnormal liver function tests, even when the clinical features are not serious. Percutaneous gallbladder drainage is an alternative therapy to cholecystectomy that can be used with selected patients. (J Intern Med Taiwan 2013; 24: 424-429)