Volume 6 Supplement 1

9th WINFOUS World Congress on Ultrasound in Emergency and Critical Care

Open Access

Emphysematous cholecystitis. Advantages of abdominal ultrasound in the ED

  • M Algaba-Montes1,
  • A Oviedo-García1,
  • D Nuñez-Hospital2,
  • J Lopez-Libano3,
  • JM Alvarez-Franco4,
  • N Diaz-Rodriguez5 and
  • A Rodriguez-Lorenzo6
Critical Ultrasound Journal20146(Suppl 1):A7

https://doi.org/10.1186/2036-7902-6-S1-A7

Published: 31 January 2014

Background

Emphysematous cholecystitis (EC) is an entity with high morbidity and mortality, and therefore require a diagnosis agile and dynamic, allowing appropriate management to avoid complications. The emergency ultrasound (US) allows a versatile and comprehensive management, improving the prognosis of this disease in the majority of cases.

Objective

we present a case of EC, diagnosed at ER, through the use of US scanning used by Emergency Phisicians.

Patients and methods

a patient with abdominal pain, with a final diagnosis of an EC assessing US, performed by EP.

Results

We report the case of a 72 year old patient with prior stroke without sequelae and hypertensive, with abdominal pain of 7 days duration, high fever and bilious vomiting. Physical examination was marked hypotension (80/45 mmHg), distal coldness, pallor and sweating, 38.5 ° C, 145 spm. The distended abdomen with abolished peristalsis and positive Murphy right upper quadrant. Rest without findings of interest. Analytically glucose was 505 mg / dl, creatinine of 2.44 mg / dl, bilirubin 2.2 mg / dl, AST 350, LDH 407, amylase 125, 19500 leukos with neutrophilia and pH of 7.13, with lactic 12. Was performed in consultation abdominal US showed a thickened gallbladder wall (8 mm), well-circumscribed, oval, distended and gas in the same light, compatible with emphysematous cholecystitis. Support measures were initiated, antibiotics, insulin therapy and emergency surgery was indicated. This allowed a favorable high after joining UCI in 7 days without further complications.

Conclusion

EC is a rare entity that represents 1% of all cholecystitis, clinically indistinguishable, but with a worse prognosis (25% mortality) and more complications. Here debut comes as poorly controlled diabetes. The use of abdominal US in ER allows for both a rapid and versatile, with proper treatment start, this being vital to good patient outcomes.

Authors’ Affiliations

(1)
Emergency Department, Valme Hospital, Seville, Members of the Working Group of Ultrasound SEMES_Andalucía and SEMERGEN
(2)
Emergency Department, Valme Hospital
(3)
Critical Care Department, Miramar Hospital, Mallorca, Member of the Working Group of Ultrasound SEMERGEN
(4)
Emergency Department, IB-Salut, Ibiza, Member of the Working Group of Ultrasound SEMERGEN
(5)
Primary Care. Barbadás Primary Care Center, Ourense, Member of the Working Group of Ultrasound SEMERGEN
(6)
Radiology Department, Perpetuo Socorro Hospital, Vigo, Member of the Working Group of Ultrasound SEMERGEN

References

  1. Fox JC, Solley M, Anderson CL, et al.: Prospective evaluation of emergency physician performed bedside ultrasound to detect acute appendicitis. Eur J Emerg Med 2008,15(2):80–5. 10.1097/MEJ.0b013e328270361aPubMedView ArticleGoogle Scholar

Copyright

© Algaba-Montes et al; licensee Springer. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.