急性氣腫性膽囊炎：一病例報告

Acute Emphysematous Cholecystitis: A Case Report

陳青富(Ching-Fu Chen) ； 王蒼恩(Tsang-En Wang) ； 林錫泉(Shee-Chan Lin) ； 張文熊(Wen-Hsiung Chang) ； 施壽全(Shou-Chuan Shih)

《內科學誌》 19卷4期 (2008/08) Pp. 360-364

https://doi.org/10.6314/JIMT.2008.19(4).11

摘要

急性氣腫性膽囊炎是急性膽囊炎的一種少見的形式，它是由產氣性致病菌所感染，疾病進展快速，致死性高，與一般急性膽囊炎不同的是它較常發生於老年人及糖尿病患，也常導致膽囊穿孔及死亡而需緊急手術治療。因膽囊內氣體的存在，導致膽囊辨識不易，使氣腫性膽囊炎較難由超音波來診斷。利用腹部X光或電腦斷層來檢視膽囊內氣體的存在是較敏感的診斷工具。我們報告一位80歲男性病患，沒有糖尿病病史，住院主訴右上腹部脹痛，沒有發燒、嗯心嘔吐及Murphy's Sign等急性膽囊炎的典型症候表現，經腹部電腦斷層檢查後，確診爲急性氣腫性膽囊炎併膽囊穿孔而接受緊急膽囊切除手術治療，術後複原良好，血液及術中膽汁培養出Clostridium Perfringens茵。急性氣腫性膽囊炎的老年患者，經常只以右上腹脹痛表現而缺乏典型的症候，術前診斷不容易，當超音波檢查發現膽囊無法清楚顯現而懷疑膽囊內有氣體存在時，必須安排腹部X光及電腦斷層作更進一步確認，一旦確立診斷，必須作緊急手術治療以降低死亡的危險性。

關鍵字

急性膽囊炎 ； 氣腫性膽囊炎 ； 膽結石

並列摘要

Emphysematous cholecystitis is a relatively rare variant but rapidly progressive and life threatening form of acute cholecystitis caused by gas-producing organisms. In contrast to acute cholecystitis, emphysematous cholecystitis occurs more commonly in elderly and diabetic patients, and is frequently associated with perforation and death, requiring emergent surgical intervention. Because poor visualization of the gallbladder in abdominal sonogram, emphysematous cholecystitis is very difficult to diagnose in most of cases. Plain film or computed tomography, are more sensitive in detecting and characterizing the gas in the gallbladder. We present a 80-year-old man with no diabetes presented with right upper abdominal pain, but without typical symptoms of acute cholecystitis as fever, nausea, vomiting and Murphy's sign after admission. Emphysematous cholecystitis with gallbladder perforation was confirmed by computed tomography. Emergent cholecystectomy was performed immediately and Clostridium perfringens was isolated from the bile and blood culture. He had an uneventful postoperative recovery. Elderly patients who have emphysematous cholecystitis may present with only right upper abdominal pain. Other signs may be absent. Preoperative diagnosis can be difficult. When the gallbladder is poorly visualized and gas is suspected on ultrasonography, it should be defined by plain film and computed tomography and emergent cholecystectomy is needed to minimize the risk of mortality.

並列關鍵字

Acute cholecystitis ； Emphysematous cholecystitis ； Gallstone