Pneumoperitoneum secondary to emphysematous cholecystitis: A
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We herein report a case of emphysematous cholecystitis (EC) causing pneumoperitoneum with gross ascites, which is a very rare entity. A 64-year-old diabetic man was admitted with diffuse abdominal pain, abdominal distension and fever of 1 week duration. On examination, patient was febrile (38.7°C) and abdominal guarding noted. Laboratory investigations revealed total leukocyte count of 16000/µl with 90% neutrophils, total bilirubin level of 2 mg/dl (direct 0.60 mg/dl). In erect X-ray abdomen, there was no significant finding. Ultrasonography (USG) abdomen showed cholelithiasis with thickened edematous gallbladder (GB) wall and few reflective echoes in GB fossa. Computed tomography (CT) axial sections revealed the presence of small stones in the gallbladder neck and small amount of intraluminal as well as intramural air. Tiny pockets of free intraperitoneal air was also noted. On intravenous (IV) contrast, there was minimal wall enhancement. Preoperative diagnosis of emphysematous cholecystitis with pneumoperitoneum was made and the same was confirmed in the intraoperative findings. Patient underwent emergency exploratory laparotomy with cholecystectomy and was given required medical management, the postoperative course was uneventful...

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