Laparoscopy & Emphysematous Chol Successful Laparoscopic Management of Emphysematous Cholecystitis in a 75 year old Cardiac and Alzheimer’s patient- A case report and Literature review

Laparoscopy & Emphysematous Cholecystitis

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S. Islam, A. Tinnie, S. Hardeo, K. Furlong, R. Rattan, and Shiva Konduru, “Laparoscopy & Emphysematous Chol Successful Laparoscopic Management of Emphysematous Cholecystitis in a 75 year old Cardiac and Alzheimer’s patient- A case report and Literature review: Laparoscopy & Emphysematous Cholecystitis”, ijmhs, vol. 13, no. 05, pp. 2081–2088, May 2023.
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Abstract

Emphysematous cholecystitis (EC) is a life-threatening surgical emergency characterized by gangrene of the gallbladder due to an infection with gas-forming organisms. It is a severe and rare variant of acute cholecystitis commonly seen in elderly males, immune-compromised hosts, patients with arteriosclerosis, history of embolic events. Delayed presentation or diagnosis is associated with high morbidity and mortality.

Percutaneous trans-hepatic drainage of the gallbladder (GB) is the initial treatment of choice for severe acute cholecystitis in a patient with multiple comorbid conditions and unstable hemodynamic status. An interval laparoscopic cholecystectomy is usually recommended after 6 weeks. However, this drainage procedure may not serve the purpose in patients with emphysematous cholecystitis because of the frequent association of focal gangrenous patches in the gall bladder in these patients.

Laparoscopic surgery is a feasible option with an excellent postoperative outcome. However, it is often very challenging due to the distortion of the anatomy secondary to severe inflammatory changes and demands a skilled laparoscopic surgeon. We report the case of a 75 years female known as Alzheimer’s, hypertensive and congestive cardiac failure patient with a delayed presentation and decreased responsiveness, diagnosed as emphysematous cholecystitis by a contrast CT scan, who underwent successful laparoscopic management after initial periods of resuscitation. The culture of the pus from the gallbladder grew Escherichia coli. A literature search was performed to highlight the management options of these patients.

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