Pain in the right upper abomen fever and signs of a peritonitis
Air and fluid in the peritoneal cavity is fequently caused by a perforation of the digestive tract. In these cases the gallbladder does not contain air.
In this case however there is also an abnormal gallbladder with air in the gallbladder lumen.
Air within the gallbladder can be caused by:
- An ERCP if air is injected together with the contrast.
- An abnormal communication between the biliary tree and the digestive tract for example after a papillotomy, choledochoduodenostomy or gallstone perforation to the digestive tract.
In these cases air is also found in the bile ducts, but in this case the bile ducts are normal.
- An emphysematous cholecystitis.
This patient had an uneventfull medical history. This makes the diagnosis emphysematous cholecystitis the most likely cause for the air in the gallbladder. An emphysematous cholecystitis is caused by an infection with gasforming bacteria. Elderly patients and diabetics have a higher risk. One of the complications of an emphysematous cholecystitis is perforation. In the case of a perforation of an emphysematous cholecystitis, not only fluid but also air can be found in the peritoneal cavity.
Operation confirmed the diagnosis: Emphysematous cholecystitis with small stones, sludge and air in the gallbladder with perforation to the peritoneal cavity.
References
Bennett GL, Balthazar EJ. Ultrasound and CT evaluation of emergent gallbladder pathology.
Radiol Clin North Am. 2003 Nov;41(6):1203-16. Review.
Dr. Taco Geertsma is the founder of UltrasoundCases.info and a retired radiologist and has worked in the Gelderse Vallei hospital from January 1, 1983. till July 1, 2014. He was the head of the ultrasound department for many years.
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