A comparative appraisal of emphysematous cholecystitis.

Emphysematous cholecystitis is an uncommon variant of acute cholecystitis in which the causative organisms are gas-forming bacteria. Since the classic description by Hegner [1] in 1931, acute emphysematous cholecystitis has been defined clinically by the roentgenographic demonstration of air in the gallbladder lumen; in the wall, or in tissues adjacent to the wall, of the gallbladder; and elsewhere in the biliary ducts in the absence of an abnormal communication with the gastrointestinal tract. These intriguing radiographic findings in the clinical setting of acute cholecystitis have been the subject of a number of case reports and reviews that have accumulated a total of 161 cases and offered a variety of descriptive synonyms such as pneumocholecystitis, pyopneumocholecystitis, gas phlegmon of the gallbladder, and aerocholecystitis. Emphysematous cholecystitis now has become a well established roentgenographic entity, but most investigators have suggested that emphysematous cholecystitis is very similar clinically to ordinary acute cholecystitis without demonstrable air in the gallbladder or bile ducts [2-8]. The current study adds three cases to the literature, but more impor-