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Am J Surg 2019 Mar 29;217(3):485-489. Epub 2018 Oct 29.

Geisinger Medical Center, USA.

Background: Current guidelines do not specifically address optimal antibiotic duration following cholecystostomy. This study compares outcomes for short-course (<7 days) and long-course (≥7 days) antibiotics post-cholecystostomy.

Methods: This was a retrospective review of cholecystostomy patients (≥18 years) admitted (1/1/2007-12/31/2017) to one healthcare system. Read More

Ned Tijdschr Geneeskd 2018 Jun 21;162. Epub 2018 Jun 21.

Haaglanden Medisch Centrum, afd. Interne Geneeskunde, Den Haag.

Emphysematous cholecystitis is a rare presentation of cholecystitis and is caused by gas producing bacteria such as Clostridium perfringens, Klebsiella species or Escherichia coli. We describe a fatal case of a 82-year-old man who presented with abdominal pain, vomiting, fever and acute confusion. An ultrasound and subsequent CT scan showed emphysematous cholecystitis. Read More

Case Rep Gastrointest Med 2017 21;2017:1971457. Epub 2017 Mar 21.

Department of Gastroenterology, Tallaght Hospital and Trinity College, Dublin, Ireland.

A 45-year-old woman with suspected Functional Biliary Sphincter Disorder (FBSD) developed related emphysematous cholecystitis after ERCP. A low index of suspicion for emphysematous cholecystitis in this young, otherwise healthy woman led to a significant delay in making the correct diagnosis, and air in the gallbladder was wrongly attributed to a possible gallbladder perforation. ERCP is associated with significant risks, particularly in patients with FBSD, where diagnostic uncertainty renders the balance of risk versus benefit even more critical. Read More

J Visc Surg 2016 11 31;153(5):395-397. Epub 2016 May 31.

Service de chirurgie digestive et vasculaire, centre hospitalier Dax-Côte d'Argent, boulevard Yves-du-Manoir, BP323, 40100 Dax cedex, France. Electronic address:

Acta Chir Belg 2016 Feb;116(1):54-7

a Department of Surgery , Laurentius Hospital, Roermond , The Netherlands.

Emphysematous Cholecystitis is life threatening if left untreated. It is associated with arteriosclerosis, embolic events, and diabetes mellitus. In this report, a patient was presented with an early diagnosis of Emphysematous Cholecystitis and was treated by cholecystectomy without complications. Read More

J Vet Intern Med 2016 Jul 20;30(4):1046-55. Epub 2016 May 20.

School of Veterinary Medicine, University College Dublin, Dublin, Ireland.

Background: Bacterial cholangitis and cholecystitis are rarely reported, poorly characterized diseases in the dog.

Objectives: To characterize the clinical features of these conditions.

Animals: Twenty-seven client-owned dogs with bacterial cholangitis, cholecystitis, or both. Read More

BMJ Case Rep 2016 Feb 11;2016. Epub 2016 Feb 11.

Department of Internal Medicine, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.

An 86-year-old man presented with severe pain in the upper abdomen along with fever. On physical examination, we found an arterial blood pressure of 84/43 mm Hg, a heart rate of 80 bpm and a temperature of 38.3°C. Read More

Case Rep Med 2015 1;2015:523402. Epub 2015 Jul 1.

Internal Medicine Residency of Spokane, University of Washington Medical School, Spokane, WA 99204, USA.

Context. Clostridium perfringens septicemia is often associated with translocation from the gastrointestinal or gastrourinary tract and occurs in patients who have malignancy or are immunocompromised. Clostridium perfringens septicemia is usually fatal without early identification, source control, and antibiotics. Read More

Clin Microbiol Infect 2015 Sep 27;21(9):851.e1-9. Epub 2015 May 27.

Department of Biotechnology, Dalian Medical University, Dalian, China. Electronic address:

Acute cholecystitis (AC) is one of the most common surgical diseases. Bacterial infection accounts for 50% to 85% of the disease's onset. Since there is a close relationship between the biliary system and the gut, the aims of this study were to characterize and determine the influence of gut microbiota on AC, to detect the pathogenic microorganism in the biliary system, and to explore the relationship between the gut and bile microbiota of patients with AC. Read More

Case Rep Gastroenterol 2014 Sep-Dec;8(3):404-7. Epub 2014 Dec 24.

Department of Internal Medicine, Saint Joseph Hospital, Chicago, Ill., USA.

Emphysematous cholecystitis is an uncommon and dangerous complication of acute cholecystitis. Common risk factors for this disease include male gender, old age, presence of diabetes mellitus and cholelithiasis. The disease is best treated with emergent surgery and parenteral antibiotics. Read More

Bull Soc Pathol Exot 2014 Dec 26;107(5):299-301. Epub 2014 Aug 26.

Allée des Topazes, Centre hospitalier universitaire de La Réunion, site Félix Guyon, CS 11021, 97400, Saint-Denis, Réunion, France,

We report two cases of septic shocks due to Salmonella non typhi infection on sickle cell patients admitted to an intensive care unit. Such patients should enforce food hygiene measures, especially under tropical settings, to avoid potentially deadly severe infections. Read More

Surg Clin North Am 2014 Feb;94(1):1-30

Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street, CPZ 810, Boston, MA 02114, USA. Electronic address:

Infectious and inflammatory diseases comprise some of the most common gastrointestinal disorders resulting in hospitalization in the United States. Accordingly, they occupy a significant proportion of the workload of the acute care surgeon. This article discusses the diagnosis, management, and treatment of appendicitis, acute cholecystitis/cholangitis, acute pancreatitis, diverticulitis, and Clostridium difficile colitis. Read More

Crit Care Clin 2013 Oct 16;29(4):1017-44. Epub 2013 Aug 16.

Department of Surgery, St. Michael's Hospital, 30 Bond Street 16CC-044, Toronto, Ontario M5B1W8, Canada.

Patients in the setting of the intensive care unit can develop intra-abdominal complications that may worsen outcome. Clinical suspicion of such complications coupled with early diagnosis and treatment may reduce morbidity and mortality associated with these processes. This article addresses the diagnosis and management of some of the common causes of intra-abdominal catastrophes. Read More

ACG Case Rep J 2013 Oct 8;1(1):51-4. Epub 2013 Oct 8.

Department of Digestive Diseases, Yale University School of Medicine, New Haven, CT.

A 48-year-old female developed acute emphysematous cholecystitis after an endoscopic retrograde cholangiopancreatography (ERCP) for evaluation of sphincter of Oddi dysfunction. Cholecystectomy was performed 2 days later. Cultures grew Clostridium perfringens. Read More

MMW Fortschr Med 2013 Jun;155(12):38-9

Klinikum Region Hannover GmbH, Klinikum Siloah, Medizinische Klinik I, Hannover.

Surg Infect (Larchmt) 2013 Oct 16;14(5):483-5. Epub 2013 Jul 16.

1 Department of Surgery, University of Michigan Hospital and Health Systems , Ann Arbor, Michigan.

Ann R Coll Surg Engl 2013 Jul;95(5):345-8

Cwm Taf Health Board, UK.

Introduction: It has been demonstrated previously that the identification of bactibilia during cholecystectomy is associated with the presence of one or more risk factors: acute cholecystitis, common duct stones, emergency surgery, intraoperative findings and age >70 years. Current evidence-based guidance on antibiotic prophylaxis during laparoscopic cholecystectomy (LC) is based on elective procedures and does not take into account these factors. The aim of this study was to assess the effectiveness of a selective antibiotic prophylaxis policy limited to high risk patients undergoing LC with the development of port site infections as the primary endpoint. Read More

World J Gastroenterol 2013 Jan;19(4):604-6

Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo 1308575, Japan.

Emphysematous cholecystitis is a rare variant of acute cholecystitis with a high mortality rate. The combination of emphysematous cholecystitis and pneumoperitoneum is also rare. We herein describe a case of emphysematous cholecystitis with massive gas in the abdominal cavity. Read More

Ann Clin Lab Sci 2012 ;42(2):162-4

Department of Pathology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA.

Here we describe a case of Clostridia glycolicum (C. glycolicum) bacteremia in a bed-ridden elderly man with chronic illnesses. The bacterium was identified by the Remel RapID ANA II System. Read More

J Microbiol Immunol Infect 2012 Oct 4;45(5):390-2. Epub 2012 May 4.

Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan.

Clostridium baratii bacteremia is a rare but severe anaerobic infection. Its major clinical features are neurological presentation, and significant risk factors include hemodialysis, intestinal disease or malignancy. We describe a case of emphysematous cholecystitis complicated by a liver abscess due to C baratii infection in a healthy adult without neurological manifestation. Read More

J Antimicrob Chemother 2012 Jun 7;67(6):1537-9. Epub 2012 Mar 7.

VA Salt Lake City Health Care System, IDEAS Center, Salt Lake City, UT 84148, USA.

Objectives: To assess the prevalence of, and the variation in, avoidable use of metronidazole in the Veterans Affairs (VA) healthcare system

Methods: Barcode Medication Administration (BCMA) data were retrospectively assessed for all patients hospitalized between January 2006 and December 2010 in acute-care wards of all VA medical centres (VAMCs) with complete BCMA data and at least 10 acute-care non-intensive care unit (ICU) beds. Potentially avoidable metronidazole days of therapy (DOT) were defined as the administration of metronidazole with another anti-anaerobic antibiotic on the same day for at least two consecutive days during the same hospitalization. Metronidazole was not considered redundant in combination with another anti-anaerobic agent within 28 days after a positive test for Clostridium difficile and during hospitalizations associated with discharge diagnosis codes for cholecystitis or cholangitis. Read More

Rev Esp Anestesiol Reanim 2011 Feb;58(2):129-31

Rev Esp Anestesiol Reanim 2010 May;57(5):314-6

Servicio de Anestesiología y Reanimación, Hospital Arquitecto Marcide, Area Sanitaria de Ferrol, A Coruña.

Massive hemolysis secondary to sepsis caused by Clostridium perfringens is a rare entity but appears fairly often in the literature. In nearly all published reports, the clinical course is rapid and fatal. We describe the case of a 75-year-old woman with diabetes who was admitted with symptoms consistent with acute cholecystitis. Read More

Int J Infect Dis 2010 Mar 5;14(3):e257-8. Epub 2009 Aug 5.

Critical Care Department, Brugmann University Hospital, Place A. Van Gehuchten, Brussels, Belgium.

We describe the case of a 46-year-old man admitted for upper gastrointestinal bleeding in the context of cirrhosis. A deep bleeding duodenal ulcer was treated by sclerotherapy. Abdominal pain and fever lead us to perform an abdominal computed tomography, which demonstrated emphysematous cholecystitis. Read More

Nihon Shokakibyo Gakkai Zasshi 2009 Feb;106(2):222-7

Department of Surgery, Hyogo Prefectural Kaibara Hospital, Japan.

We report a case of emphysematous cholecystitis (EC). An 82-year-old woman was hospitalized for subarachnoidal hemorrhage. She presented with fever, vomiting, hypotension, and slight abdominal tenderness in the right upper quadrant. Read More

BMJ Case Rep 2009 14;2009. Epub 2009 Apr 14.

Albany Medical Center, Internal Medicine, 43 Newscotland Ave, Mail Code 50, Albany, New York, 12208, USA.

An obese diabetic male presented with self limiting diarrhoea of 1 day duration, which had started after he ate sausages. Examination was unrevealing except for persistent low blood pressure. Computed tomographic (CT) scan, done to rule out retroperitoneal bleed, incidentally showed air in the gall bladder. Read More

J Chir (Paris) 2008 Sep-Oct;145(5):478

Service de chirurgie générale, hôpital Antoine-Béclère - Clamart.

Cases J 2008 Aug 7;1(1):73. Epub 2008 Aug 7.

1st Propedeutic Surgical Department, A,H,E,P,A University Hospital, Aristotle's University of Thessaloniki, Thessaloniki, Greece.

A 65-year-old Greek man with a history of diabetes mellitus and hypertension was admitted because of right upper quadrant pain, nausea and palpable right quadrant mass. On admission the patient was febrile (38.8 degrees C) with a total bilirubin level of 1. Read More

J Vet Diagn Invest 2008 Jul;20(4):527-30

Division of Veterinary Resources, National Institutes of Health, Bethesda, MD 20892, USA.

A 21-month-old domestic Hanford pig (Sus scrofa domestica) in a 1-year study for experimental myocardial infarction was euthanized at the end of the study. One week earlier, the animal had symptoms and elevated clinical chemistry results suggestive of hepatobiliary disease, which resolved after medical therapy. At necropsy, the gallbladder was markedly enlarged, discolored, and had a thickened wall. Read More

Minerva Gastroenterol Dietol 2007 Dec;53(4):383-6

Department of Hygiene, Infectious Diseases and Epidemiology, Medical Faculty, Tracian University, Stara Zagora, Bulgaria.

Clostridium difficile-associated disease (CDAD) ranges in severity from mild diarrhoea to fulminant colitis and death. Antimicrobial use is the primary risk factor for development of CDAD. C. Read More

N Engl J Med 2007 Sep;357(12):1238

Saint Louis University, St. Louis, MO 63117, USA.

J Vasc Interv Radiol 2007 Jul;18(7):940-1

J Vet Intern Med 2007 May-Jun;21(3):417-24

Department of Medical Sciences, Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706-1102, USA.

Background: Information is lacking on the prevalence and susceptibility patterns of bacterial isolates in dogs and cats with suspected hepatobiliary disease.

Objectives: To characterize the prevalence, identity, and antimicrobial susceptibility of common hepatobiliary isolates from such patients.

Animals: Dogs and cats presented to the University of Wisconsin-Madison Veterinary Medical Teaching Hospital for which samples of bile, gallbladder, or liver were submitted for culture from 1998 to 2003, including 190 dogs (192 culture episodes) and 58 cats (61 culture episodes). Read More

Surgery 2007 Mar;141(3):411-2

Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland

Clin Gastroenterol Hepatol 2007 Mar 31;5(3):e9. Epub 2007 Jan 31.

Department of Surgery, Hospital General Reina Sofia de Murcia, Hospital de la Vega Baja de Orihuela, Murcia, Spain.

J Small Anim Pract 2006 Jun;47(6):325-35

School of Agriculture, Food Science and Veterinary Medicine, College of Life Sciences, University College Dublin, Dublin 4, Republic of Ireland.

Objectives: To evaluate the clinical, clinical pathology, diagnostic imaging, microbiological and pathological features of cholangitis/cholangiohepatitis in the dog.

Methods: The study design was a retrospective review of cases of bacterial cholangitis/cholangiohepatitis presented to the University of Bristol during the period 1995 to 2000. The diagnosis was made based on hepatic histopathological findings and positive bile culture results. Read More

JSLS 2005 Oct-Dec;9(4):478-80

IRCAD, Louis Pasteur University, Strasbourg France.

Background: Emphysematous cholecystitis is a rare condition caused by ischemia of the gallbladder wall with secondary gas-producing bacterial proliferation. The pathophysiology and epidemiology of this condition differ from that in gallstone-related acute cholecystitis. This report illustrates a case of emphysematous cholecystitis successfully treated by laparoscopic surgery. Read More

J Feline Med Surg 2006 Apr 8;8(2):91-103. Epub 2005 Nov 8.

Allambie Veterinary Clinic, Allambie Heights, NSW, Australia.

Clinicopathological findings from six cats with confirmed cholecystitis or acute neutrophilic cholangitis are presented. Historical findings included lethargy and anorexia or inappetence of up to five days duration. On physical examination all cats were pyrexic and four out of six were jaundiced and had cranial abdominal pain. Read More

J Gastroenterol 2005 Jun;40(6):641-5

Department of Internal Medicine, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan.

A 79-year-old man was admitted because of cholecystitis that occurred about 40 days after sigmoidectomy had been performed for colonic cancer. Though antibiotics improved his condition, the patient had hematochezia, diarrhea, and left lower abdominal pain. Colonoscopic findings showed multiple ring-like areas of redness and petechiae in the rectosigmoid colon and marked edema from the descending to the transverse colon. Read More

J Am Vet Med Assoc 2005 May;226(10):1645-6

Animal Specialty Group Incorporated, 4641 Colorado Blvd, Los Angeles, CA 90039, USA.

Emerg Infect Dis 2004 Nov;10(11):1950-2

University of Calgary, Calgary, Alberta, Canada.

We describe a 27-year-old man with acute cholecystitis, hepatic abscess, and bacteremia caused by Clostridium hathewayi, a newly described gram-negative, endospore-forming, rod-shaped bacterium. This report is the first of human infection caused by this microorganism. Read More

Hepatobiliary Pancreat Dis Int 2004 Feb;3(1):133-5

Department of Hepatobiliary-Vascular Surgery, Affiliated Hospital of Medical College, Qingdao University, Qingdao 266003, China.

Background: The major causive factors of gallbladder carcinoma are very complex. Cholecystitis with gallstone was reported one of the most important factors. Many research revealed that cholecystitis or gallstone can give rise to epithelial hyperplasia of gallbladder mucusa or canceration secondarily. Read More

Internist (Berl) 2004 Jan;45(1):85-9

Klinik für Innere Medizin und Rheumatologie, Klinikum Bethanien Chemnitz gGmbH.

We present a case of an 81-year-old diabetic man with anaerobic sepsis due to acalculous cholecystitis. The patient was admitted to our hospital with a seven-day history of severe abdominal pain accompanied with fever and somnolence. Blood cultures taken during the initial procedure developed Clostridium perfringens. Read More

N Engl J Med 2003 Jun;348(23):2329

Inatsuki Hospital, Fukuoka 820-0207, Japan.

Med Pregl 2002 Nov-Dec;55(11-12):529-31

KBC Dr Dragisa Misović-Dedinje, 11000 Beograd, Heroja Milana Tepića 1.

Introduction: Emphysematous cholecystitis is a rare gallbladder pathology characterized by gas accumulation in the gallbladder wall as a result of severe inflammation, mostly caused by bacteria known as Clostridium species.

Case Report: This is a case report of a 59 year-old male diabetic, with typical anamnestic, clinical, ultrasonographic and radiological findings, pointing to acute cholecystitis of emphysematous form. Surgical and bacteriological procedures confirmed the preoperative findings. Read More

Gastroenterol Clin Biol 2002 Mar;26(3):289-91

Service de Chirurgie Générale et Digestive, Hôpital Foch, 40, rue Worth; BP 36, 92151 Suresnes Cedex.

Acute acalculous cholecystitis is rare in non critically ill or postoperative patients. We report a case of acute acalculous cholecystitis with secondary bile infection with Clostridium perfringens. Ultrasound and tomodensitometry revealed diffuse aerobilia. Read More

Br J Haematol 2002 May;117(2):351-8

Department of Internal Medicine I, Institute of Medical Microbiology and Immunology, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany.

A prospective study of 62 chemotherapy-induced neutropenic episodes in patients with acute leukaemia was conducted to determine the incidence and causes of abdominal infections, and to assess the diagnostic value of the combined use of ultrasonography (US) and microbiology. Each patient underwent US of liver, gallbladder and complete bowel before chemotherapy, on days 2-4 after the end of chemotherapy and in cases of fever, diarrhoea or abdominal pain. US was combined with a standardized clinical examination and a broad spectrum of microbiological investigations. Read More

Semin Roentgenol 2001 Apr;36(2):78-80

Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110027, India.

Ann Thorac Surg 2000 Dec;70(6):2143-5

Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland.

Esophageal perforation and mediastinal gas gangrene developed in a 55-year-old male after the endoscopic ethanol injection of a Mallory-Weiss ulcer. Initially, extensive gangrene of the esophagus and the mediastinum was treated by esophagectomy; however, an abundance of Clostridium perfringens in the Gram stain verified the presence of gas gangrene. Subsequently, the patient was transferred to a hyperbaric oxygen center, wherein a total of seven hyperbaric treatments were administered. Read More