Emphysematous cholecystitis in a non-diabetic patient

A 47-year-old male was admitted at our emergency room with a 4-days history of acute abdominal pain, increased by inspiration. There was neither nausea nor vomiting. Physical examination revealed right upper quadrant and right flank tenderness. The patient had no diabetes mellitus. Laboratory tests showed a white-cell count at 15 x 109 cells/L (87% neutrophils), a CRP at 44,1 mg/dL, bilirubin at 1,9 mg/dL and γGT at 114 U/L.