Acute Emphysematous Cholecystitis

急性氣腫性膽囊炎是一種少見但可能危及生命的疾病，早期診斷及治療可以獲得良好的預後。此疾病早期的表徵並不一定非常明確清晰，但病情演變有時即使積極治療也仍有敗血症的可能。此種病人的年紀一般多為六十歲至七十歲，且男性多於女性，糖尿病人則有較高罹病機率。最可能的致病原因為梭狀芽胞桿菌或其他產氣細菌侵入至原先已有膽囊感染或膽囊管阻塞的病人。此篇報告一臨床病例並做文獻回顧討論。在診斷方面，傳統腹部X光檢查及腹部超音波如果膽囊或其周圍有典型氣體出現，就要高度小心並懷疑有急性氣腫膽囊炎的可能性。在鑑別診斷或是疾病定位方面，若病情評估有需要時，則應考慮電腦斷層檢查，以確立診斷。治療方面，則以膽囊切除及充分引流為主。對於可能的致病因素、機轉、疾病生理特徵及典型放射影像特徵的瞭解與熟悉，非常有助於早期診斷和成功的治療。

關鍵字

氣腫性膽囊炎；腹部超音波；膽結石

並列摘要

Emphysematous cholecystitis is a rare but life-threatening condition. The initial clinical manifestations of the disease may be insidious, but rapid progression to sepsis may occur despite aggressive therapeutic intervention, so early diagnosis and treatment are important to prevent the catastrophic septic consequences. Conventional radiography and abdominal sonography are often the initial imaging modalities used for evaluation. Characteristic gas around the gallbladder fossa is imperative for a diagnosis of emphysematous cholecystitis. If the differential diagnosis remains or further evaluation of the severity or localization of the disease is needed, computed tomography should be considered. Knowledge of the common predisposing conditions such as diabetes and gallstones, the pathophysiologic characteristics, and typical imaging features will greatly favor a correct diagnosis and make successful treatment possible. We report on a 51-year-old male patient who complained of severe right upper quadrant pain. The clinical course, examinations, and treatment are discussed along with a review of the literature.

並列關鍵字

emphysematous cholecystitis ； abdominal sonography

國際替代計量

Acute Emphysematous Cholecystitis

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