SESAP Critique
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**C****ategory** **4 I****tem** **10**

The hallmark of acute emphysematous cholecystitis is the presence of gas bubbles on a plain x-ray or computed tomographic (CT) scan of the abdomen. This fulminant form of acute cholecystitis is caused by a mixed aerobic and anaerobic infection. It is seen more often in elderly diabetic men than any other group. Urgent operation is indicated to prevent the common sequelae of gangrene, perforation, and peritonitis. The presence of diabetes places the patient at a greater risk for complications regardless of whether the procedure is acute or elective. Intravenous hydration, systemic antibiotics directed against the organism likely encountered, and blood sugar control are also required. Antacid therapy and endoscopy have no role in the treatment of acute emphysematous cholecystitis.

## References

1.  10/1.1.  Blumgart LH
    
    Lavelle-Jones M, Cuschieri A: Acute choleycstitis, in Blumgart LH (ed): Surgery of the Liver and Biliary Tract, ed 2. New York, Churchill-Livingstone, 1994, pp 589–597
    
    

2.  10/2.Sandler RS, Maule WF, Baltus ME: Factors associated with postoperative complications in diabetics after biliary tract surgery. Gastroenterology 91:157–162, 1986
    
    [PubMed](http://canjsurg.ca/lookup/external-ref?access_num=3710064&link_type=MED&atom=%2Fcjs%2F42%2F5%2F370.atom) 
    
    [Web of Science](http://canjsurg.ca/lookup/external-ref?access_num=A1986C768800022&link_type=ISI)