Perforated gangrenous cholecystitis masquerading as adenomyo
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Clostridium perfringens (C. perfringens) is an unusual cause of bacteremia in the healthy, immunocompetent host. Similarly, acalculous cholecystitis is rare in the absence of critical illness or preceding trauma. This article presents a case of concurrent C. perfringens bacteremia and acalculous cholecystitis in a previously well human.

Case Report:

An apparently healthy 56-year-old male was presented with sepsis of unknown origin and was treated for a respiratory infection and incidentally found to have gallbladder mural thickening on a computed tomography (CT) chest scan. An abdominal ultrasound (USG) demonstrated adenomyomatosis of the gallbladder, without evidence of acute cholecystitis or gallstones. The initial blood sample hemolyzed, however, subsequent specimens showed raised inflammatory markers, neutrophilia, and thrombocytopenia.

The patient continued to deteriorate clinically and biochemically. At 30 hours from presentation, blood cultures demonstrated a C. perfringens bacteremia and intravenous antibiotics were commenced. Following these findings and the development of right upper quadrant abdominal pain, biliary sepsis was suspected and the patient was taken to theatre. During laparoscopic cholecystectomy, a perforated and gangrenous gallbladder was identified and the intraoperative cholangiogram demonstrated no retained stones. Acute gangrenous cholecystitis was confirmed on histopathology. Postoperatively, the patient recovered quickly and was discharged with oral antibiotics.

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