- 期刊
Insidious Presentation of Emphysematous Cholecystitis in a Type 2 Diabetic Man
糖尿病病患罹患氣腫性膽囊炎的隱伏表現
摘要
一位77歲男性糖尿病病患因黃疸與噁心一週就醫，腹部超音波顯示高迴音的膽囊壁及正常的總膽管。電腦斷層顯示在膽囊腔與膽囊壁出現氣體，符合氣腫性膽囊炎的表現。該病患接受抗生素與經皮膽囊引流治療，順利出院。我們在此討論本氣腫性膽囊炎病例不常見的隱伏性表現，以及影像學檢查在鑑別診斷氣腫性膽囊炎與膽囊肌腺瘤症時的陷阱。當糖尿病病患出現異常肝功能檢查，且超音波檢查發現膽囊壁有聲波偽影及反射陰影時，即使臨床表現不甚嚴重，仍應考慮儘早安排電腦斷層檢查。對於不適合接受膽囊切除且臨床不甚危急的病患，可以採用經皮膽囊引流治療。
關鍵字
無資料並列摘要
We present the clinical course of a 77-year-old diabetic man with jaundice and nausea for one week. An abdominal ultrasound examination revealed a hyperechoic gallbladder wall and a normal common bile duct. Computed tomography disclosed air in the gallbladder lumen as well as intramural air; these are consistent with emphysematous cholecystitis. He was treated with antibiotics and percutaneous gallbladder drainage and finally was discharged uneventfully. We discuss the unusual insidious presentation of emphysematous cholecystitis in this patient, together with the pitfalls related to imaging studies of emphysematous cholecystitis as compared with gallbladder adenomyomatosis. Computed tomography should be considered early when examining diabetic patients who have acoustic artifacts and reverberation shadows on ultrasonography when this is linked to abnormal liver function tests, even when the clinical features are not serious. Percutaneous gallbladder drainage is an alternative therapy to cholecystectomy that can be used with selected patients.