Emphysematous Cholecystitis in a Patient with Type 2 Diabetes Mellitus: A Case Report

Acute emphysematous cholecystitis is a rare and severe form of acute cholecystitis, representing approximately 1% of cases. This condition is characterized by a necrotizing infection, with the hallmark feature being the presence of gas within the gallbladder. Here we present a case of a diabetic patient who suffered from EC with normal liver function tests. 69-year-old woman with a 10-year history of type 2 diabetes mellitus treated with oral antidiabetics, who was admitted to the emergency department with right upper quadrant abdominal pain, fever, and general malaise. Clinical examination revealed stable vital signs and localized tenderness in the right hypochondrium. Laboratory investigations showed leukocytosis, normal liver enzymes and bilirubinemia, increased inflammatory markers. Abdominal ultrasound revealed an alithiasic thickened gallbladder wall with intramural gas and pericholecystic fluid, suggestive of emphysematous cholecystitis. This diagnosis was confirmed by computed tomography, which also showed a gas dissecting along the entirety of the gallbladder wall and small fluid effusion in the douglas pouch. The patient underwent urgent open cholecystectomy, during which a necrotic gallbladder was removed. EC is a severe variant of acute cholecystitis with a poor prognosis if not promptly and accurately diagnosed. Computed tomography (CT) remains the most specific imaging tool for diagnosis. The cornerstone of treatment is timely cholecystectomy, which is essential to reduce both morbidity and mortality.