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Portal cavernoma cholangiopathy (PCC) refers to morphological changes in the intrahepatic, extrahepatic biliary system, along with the gallbladder (GB), induced by portal cavernoma (PC). Acute acalculous cholecystitis (AAC) represents an infrequent clinical manifestation of PCC. Given the inadequacy of documentation within medical literature, AAC may go undiagnosed among patients with PC presenting symptoms of right upper quadrant pain. The current study aims to report a case of acute acalculous cholecystitis secondary to portal cavernoma, focusing on radiological findings, with a brief review of literature.

Aim: The clinical picture of acute stoneless cholecystitis can be seen in a wide range from mild lesions to the size that threatens the patient’s life. In this study, we aimed to contribute to the literature by investigating the relationship between patients with acute stone-free cholecystitis and diabetes mellitus (DM). Materials and Methods: Patients were analyzed for age, sex, and blood tests. Descriptive statistics for numerical variables are presented as mean, standard deviation, min-max values. Non-parametric test procedures were performed on non-normally distributed data. In this context, dependent and independent sample t-test and Mann-Whitney U test were used to determine the relationships between the parameters. Spearman’s correlation analysis was used, and chi-square analysis was performed to evaluate the relationship between categorical data. Results: The parameters measured by complete blood count and biochemistry were as follows: neutrophil: 56.72±23.17, C-reactive protein (CRP): 38.31±7.70, aspartate aminotransferase (AST): 78.86±25.80, alanine aminotransferase (ALT): 73.59±159.90, gamma glutamyl transferase (GGT): 142.99±236.08, urea: 37.14±24.41, creatinine: 0.90±0.50, glucose: 115.42±53.70, white blood cell: 8.49±6.66, percentage of neutrophils: 63.80±14.10, platelet: 245.63±84.62. There was a positive correlation between CRP and AST, CRP and ALT, CRP and GGT, and ALT and GGT in DM+ patients. Conclusion: It can be said that advanced age and the presence of DM increase the risk of stoneless cholecystitis, and blood parameters are used to show the presence of infection. In addition, deterioration in liver function tests increases more in patients with DM.

Abstract Background Acute hepatitis A infection is common among children in developing nations. The clinical presentation in children is usually asymptomatic and anicteric, and it is a self-limiting infection. Rarely, it can be associated with extrahepatic complications such as pleural effusion, acalculous cholecystitis, and ascites. Case presentation An 8-year-old middle eastern child presented with abdominal pain, jaundice in the sclera, yellowish color of urine, and poor appetite. In the last two days, abdominal distension developed. After conducting diagnostic investigations, the child was diagnosed with HAV hepatitis associated with bilateral pleural effusion, acalculous cholecystitis, and ascites. He was managed conservatively with vitamin K supplementation and supportive parenteral fluids. After 4 days, clinical improvement was observed. Conclusion Hepatitis A infections presented with extrahepatic manifestations like pleural effusion, acalculous cholecystitis, and ascites are very rare, especially in children. There have been some reports of these manifestations occurring in isolation, but for them to co-exist to our knowledge, this has only been reported in two cases in the literature, and this is the third case with all these three rare complications being presented simultaneously in a single child. Although HAV infection is an asymptomatic and self-limiting viral disease in childhood, it can manifest with rare extrahepatic complications, so pediatricians should be aware of this rare association to avoid unnecessary investigations.

Key Clinical Message In patients with symptoms of viral infection and marked thickening of the gallbladder wall, it is important to suspect acalculous cholecystitis due to Epstein–Barr virus‐induced infectious mononucleosis. Abstract A 35‐year‐old Japanese man presented with fever, abdominal right upper quadrant pain, and liver dysfunction. Positive immunoglobulin M and ‐G antibodies and negative nuclear antigen for Epstein–Barr virus were observed. Abdominal ultrasonography revealed a markedly thickened gallbladder wall. Acalculous cholecystitis due to Epstein–Barr virus‐induced infectious mononucleosis was diagnosed.

Key Clinical Message When seeing patients who present with atypical lymphocytes and abdominal pain without accompanying symptoms of pharyngitis or lymphadenopathy, acalculous cholecystitis caused by CMV infection should be considered as a differential diagnosis. Abstract A teenage man presented with a fever and epigastric pain. The patient tested positive for cytomegalovirus IgG and IgM. Abdominal ultrasonography and contrast‐enhanced CT revealed hepatosplenomegaly and gallbladder wall thickening. MRI did not identify gallstones or tumorous lesions. He was diagnosed with infectious mononucleosis and acalculous cholecystitis caused by cytomegalovirus.

Most hepatitis A infections are acute, self-limiting, and asymptomatic. In rare instances, an extrahepatic complication, like acute cholecystitis, may emerge. Acute cholecystitis is inflammation of the gallbladder wall and is classified into calculous and acalculous. About 90%–95% of cases are brought on by bile duct stones. Acute acalculous cholecystitis (AAC) can be brought on by the structural and functional abnormalities in the gallbladder brought on by viral hepatitis infection. Here, we present a 20-year-old female patient with AAC associated with hepatitis A infection. The patient came with acute epigastric pain, fever, and elevated liver function test. Computed tomography scan examination showed the results of diffuse thickening of the gallbladder wall (8 mm) and pericholecystic fluid without any calculous found, and the serology for viral hepatitis suggested acute hepatitis A infection with positive anti-hepatitis A virus (HAV) immunoglobulin M. Gallbladder distention, thickening of the gallbladder wall, the absence of an acoustic shadow or biliary sludge, perivesical liquid buildup, and the absence of dilatation of the intra- and extrahepatic bile ducts are among the ultrasonographic criteria for diagnosing AAC. Hepatitis A testing should be considered in patients suspected of having acalculous cholecystitis of an undefined etiology in markedly deranged liver function tests in adult patients.

Abstract Background This study aimed to understand the incidence and clinical significance of acalculous cholecystitis in patients with acute hepatitis E (HE). Patients and methods A single center enrolled 114 patients with acute HE. All patients underwent imaging of the gallbladder, and patients with gallstones and cholecystectomy were excluded. Results Acalculous cholecystitis was found in 66 patients (57.89%) with acute HE. The incidence in males was 63.95%, which was significantly higher than in females (39.29%) (P = 0.022). The mean length of hospital stay and the incidence of spontaneous peritonitis in patients with cholecystitis (20.12 ± 9.43 days and 9.09%, respectively) were significantly higher than those in patients without cholecystitis (12.98 ± 7.26 days and 0%, respectively) (P

OBJECTIVE: To assess the incidence of acute acalculous cholecystitis in patients with dengue fever and assess its association with laboratory parameters. METHODOLOGY: This cross-sectional study was conducted in Creek General Hospital, United Medical and Dental College, Karachi, Pakistan, from September 2020 to October 2021. Patients were included in the study through consecutive sampling. After their informed consent, all adult patients diagnosed with dengue fever, based on serological tests, were included in this study. Exclusion criteria were co-existing cholelithiasis, chronic liver disease, hemolytic and rheumatological disorders, metabolic syndrome, dyslipidemia, chronic kidney disease, use of oral contraceptive pills, pregnant females, enteric fever, vasculitis and recent surgery or trauma.The ultrasonographic features of these patients were recorded along with other laboratory investigations. SPSS ver 23.0 was used to analyze the data. Student t-tests and Chi-square tests were used to assess the association between the variables, and a P-value of

Acute acalculous cholecystitis (AAC) represents cholecystitis without gallstones, occurring in approximately 5–10% of all cases of acute cholecystitis in adults. Several risk factors have been recognized, while infectious diseases can be a cause of cholecystitis in otherwise healthy people. Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has spread worldwide, leading to an unprecedented pandemic. The virus enters cells through the binding of the spike protein to angiotensin-converting enzyme 2 (ACE2) receptors expressed in many human tissues, including the epithelial cells of the gastrointestinal (GI) tract, and this explains the symptoms emanating from the digestive system. Acute cholecystitis has been reported in patients with COVID-19. The purpose of this review is to provide a detailed analysis of the current literature on the pathogenesis, diagnosis, management, and outcomes of AAC in patients with COVID-19.

Primary Epstein-Barr virus (EBV) infection manifests with diverse clinical symptoms, occasionally resulting in severe complications. This scoping review investigates the rare occurrence of acute acalculous cholecystitis (AAC) in the context of primary EBV infection, with a focus on understanding its prevalence, clinical features, and underlying mechanisms. The study also explores EBV infection association with Gilbert syndrome, a condition that potentially exacerbates the clinical picture. Additionally, a case report of an 18-year-old female presenting with AAC and ascites secondary to EBV infection enhances the review. A comprehensive literature review was conducted, analyzing reported cases of AAC secondary to EBV infection. This involved examining patient demographics, clinical presentations, laboratory findings, and outcomes. The search yielded 44 cases, predominantly affecting young females. Common clinical features included fever, cervical lymphadenopathy, tonsillitis/pharyngitis, and splenomegaly. Laboratory findings highlighted significant hepatic involvement. The review also noted a potential link between AAC in EBV infection and Gilbert syndrome, particularly in cases with abnormal bilirubin levels. AAC is a rare but significant complication of primary EBV infection, primarily observed in young females, and may be associated with Gilbert syndrome. This comprehensive review underscores the need for heightened clinical awareness and timely diagnosis to manage this complication effectively.

Abstract Background Gastrointestinal complications are becoming increasingly more common and pose a significant risk on the health of children with compromised immunity caused by various etiologies such as chemotherapy and posttransplantation immunosuppression. We aim to review abdominal complications in immunocompromised children and their respective management. Main body This is a scoping review of the literature. PubMed, MEDLINE, Google Scholar, and Scopus libraries were searched for relevant articles. Extracted data included the etiologies of immunocompromised immunity, gastrointestinal and abdominal complications in immunocompromised children, diagnosis, and treatment of these pathologies. Examples of gastrointestinal complications in immunocompromised children include, but not limited to, neutropenic enterocolitis, acute appendicitis, bowel perforation, acalculous cholecystitis, and acute pancreatitis. Our literature review showed that bacterial and fungal infections are the major causes of exacerbation and mortality. The main cause of immunosuppression in children with neutropenic enterocolitis and acute pancreatitis is chemotherapy, and management of these pathologies using intravenous fluids, antibiotic therapy, and granulocyte-stimulating factors is the current standard of care. Surgical intervention is uncommon and reserved for complicated cases. That said, in acute appendicitis and bowel perforation, laparoscopy is the mainstay treatment. However, in systemic infections, nonsurgical interventions such as transfusion and bowel rest are the gold standard. As for acalculous cholecystitis, percutaneous cholecystectomy is superior to laparotomy and other surgical interventions. Conclusion Timely diagnosis and management of gastrointestinal complications in the immunocompromised children is key in reducing mortality and morbidity. Both surgical and nonsurgical interventions are needed and should be further studied in order to improve outcomes.

Abstract Hepatitis A virus (HAV) has some life‐threatening extrahepatic complications, such as acute acalculous cholecystitis (AAC). We present HAV‐induced AAC in a young female, based on clinical, laboratory, and imaging findings, and conduct a literature review. The patient became irritable, which progressed to lethargy, as well as a significant decline in liver function, indicating acute liver failure (ALF). She was immediately managed in the intensive care unit with close airway and hemodynamic monitoring after being diagnosed with ALF (ICU). The patient's condition was improving, despite only close monitoring and supportive treatment with ursodeoxycholic acid (UDCA) and N‐acetyl cysteine (NAC).

Acute acalculous cholecystitis has been associated with critically ill and elderly patients.In the pediatric population, the etiology of this pathology could be an uncommon but potentially significant complication of Epstein-Barr virus infection. This virus is very common in young adults and is associated with fatigue, muscle aches, fever, and in some instances can present with transaminitis and jaundice. This transient hepatocellular injury could lead to gallbladder inflammation. We are going to present our experience and treatment in two patients that presented with abdominal pain and a positive mononucleosis test.

Abstract Background With the increasing number of dengue virus infections imported into Germany, knowledge about the different phases of the disease and possible complications is essential for the treatment of patients. The virus is endemic in the tropics and subtropics and up to 2.5 billion people are at risk of infection. Case presentation Here we present a German traveller with dengue shock syndrome after returning from Thailand. After hospitalization the patient developed acute upper abdominal pain. The ultrasound findings were consistent with an acute acalculous cholecystitis, but were interpreted as dengue associated gallbladder wall thickening (GBWT). Therefore a surgical intervention was not indicated and would have been associated with an higher risk of complications in this situation. Under supportive care spontaneous regression of GBWT could be documented by sonography four days later as well as complete resolution of clinical symptoms. Conclusion GBWT in dengue virus infection mimicking acute cholecystitis is a differential diagnosis one should take into consideration in travellers returning from endemic areas and should be managed conservatively because of an high risk of bleeding and increased mortality under surgical therapy.

Acute pericarditis is the most common inflammatory disorder of the pericardium, responsible for approximately 5% of visits to the emergency departments, concerning chest pain without myocardial infarction. We report a case of a 41-year-old man who presented to our hospital, complaining about retrosternal and epigastrium pain. The transthoracic echocardiogram showed pericardial effusion while the electrocardiogram and laboratory findings revealed acute pericarditis. An abdominal ultrasound revealed gallbladder edema. The pericardial effusion was treated with pericardial catheter insertion, diuretics, and nonsteroidal anti-inflammatory drugs. This case shows that acute pericarditis can be clinically presented with many ways, one of them being gallbladder edema. Furthermore, in this case-based review we present all cases of simultaneous appearance of pericarditis and acalculous cholecystitis or gallbladder edema.

Abstract We described a rare case of vaccine‐induced acalculous cholecystitis (ACC). A 52‐year‐old female developed ACC after 8 h of receiving a 3rd dose of the Pfizer‐BioNTech COVID‐19 vaccination. The symptoms subsided completely with conservative treatment for 12 days, and the ultrasound and laboratory findings went back to normal.

A 64-year-old man was treated with sunitinib as a first-line therapy for metastatic renal cell carcinoma. He was given oral sunitinib in cycles of 50 mg once daily for 2 weeks followed by a week off. During the 5th week of treatment right upper quadrant pain developed, but this resolved spontaneously during the 6th week (off treatment). However, on the 8th week of treatment, he was admitted to hospital because the acute right upper quadrant pain recurred with nausea, vomiting, and fever. Acute acalculous cholecystitis was then diagnosed by ultrasonography and CT. In addition, his laboratory findings indicated disseminated intravascular coagulation. Accordingly, sunitinib therapy was discontinued and broad-spectrum antibiotics initiated. He subsequently recovered after emergent percutaneous cholecystostomy. His Naranjo Adverse Drug Reaction Probability Scale score was 7, indicaing a probable association of the event with sunitinib. Suspicion of sunitinib-related acute cholecystitis is required, because, although uncommon, it can be life-threatening.

Acute-on-chronic mesenteric ischemia (CMI) leading to gallbladder gangrene is a rare event, and successful use of mesenteric arterial reimplantation with regard to contaminated field is not reported. In contaminated field from gangrenous gallbladder due to acute-on-CMI, reimplantation of the superior and inferior mesenteric artery (SMA and IMA, respectively) for revascularization is a feasible option, and was used to revascularize in this patient. SMA and IMA require one anastomosis at the aorta, and it was successfully used in contaminated field to revascularize the threatened bowel. In acute-on-CMI, with contaminated field, reimplantation of SMA makes one of an option in surgical armamentarium of using autologous tissue and it reduces number of anastomosis in infected field. Acalculous gangrenous cholecystitis is a rare pathology associated with acute-on-CMI.

Cholesterol embolization syndrome (CES) is an atherosclerotic complication affecting different systems with various clinical manifestations, usually triggered iatrogenically by interventional and surgical procedures or thrombolytic therapy, although spontaneous cases have been reported. The hepatobiliary system can also be affected when the showered cholesterol crystals obliterate small vessels within this system causing both ischaemic and inflammatory responses. We describe a case of a male patient who initially developed multiple lacunar cerebral infarcts 10 days post-thrombolytic therapy and percutaneous coronary intervention (PCI) due to acute myocardial infarction. Several weeks later he developed acalculous cholecystitis complicated by liver abscess and kidney injury. The consequences and latency of manifestations within different organs and the temporal relationship with well-known trigger factors raised the suspicion of CES.

Epstein-Barr virus (EBV) is a member of the herpes virus family and is characterized by fever, lymphadenopathy, and sore throat. In this report, we present a 20-year-old woman with a four-day history of fever, chills, nausea, vomiting, jaundice and abdominal pain, and a diagnosis of acalculous cholecystitis, acute hepatitis with hemolytic anemia due to infectious mononucleosis. After the confirmation of acute acalculous cholecystitis along with hemolytic anemia, prednisolone was initiated for the patient. Supportive measures resolved the symptoms of acalculous cholecystitis.

Introduction: Classic dengue fever presentation has expanded its horizon by involving various organ systems and is named as expanded dengue syndrome. This changing presentation and rising burden across the globe may lead to delayed diagnosis and under reporting of this syndrome. Aim of Study: To analyze clinicolaboratory profile of patients with expanded dengue syndrome. Materials and Methods: About 520 cases of expanded dengue syndrome as per World Health Organization definition criteria 2012 were studied with their informed consent. Detailed history, thorough clinical examination, and relevant investigations were done. Their clinical and laboratory parameters were analyzed. Standard treatment guidelines were followed in all cases. Observation: About 301 patients were male and 219 were female with male-to-female ratio of 3:2. Their age varied from 12 to 76 years with the average age of 47.5 years. About 92% of cases presented with various gastro hepatic manifestations. The commonest gastrohepatic manifestation was transaminitis (57.5%) that is asymptomatic elevation of liver enzymes followed by acalculous cholecystitis (21%) and acute pancreatitis (13.9%). Twenty-nine patients presented with various neurological manifestations. Three patients presented with acute kidney injury and eight patients had coinfection with malaria. Fever with nausea and vomiting was the most common presentation. About 15% of patients presented with bleeding manifestations. About 40.6% of patients presenting as abdominal manifestations had platelet count

Introduction. Takayasu’s arteritis or pulseless disease is a systemic inflammatory disease of an unknown etiology, affecting medium and large arteries and their branches, leading to stenosis, occlusions, or aneurysmal degeneration. It is more frequent in young Asian women. Case presentation. We present a rare case of Takayasu’s disease in a young woman, who initially developed an acute ischemic cholecystitis. Ischemia is one of the mechanisms involved in the pathogenesis of acute acalculous cholecystitis. As this mechanism is most often involved in elderly people, such an uncommon finding at young age should be a reason to suspect a vasculitis with small vessel occlusion. Conclusions. Acute cholecystitis in this patient was the first onset sign of Takayasu’s arteritis. An acute acalculous cholecystitis at young age could be of ischemic origin and should also be considered as a possible epiphenomenon of a generalized vasculitis disease.

Nausea and vomiting manifest in more than 50% of pregnancies; in case of severe nausea and vomiting during pregnancy, or hyperemesis gravidarum, other diagnoses should be considered. This case report details a 34-year-old pregnant woman with diabetes whose primary symptom was nausea and vomiting; she presented with mild abdominal pain without abdominal tenderness. After hospital admission, she was treated as a case of hyperemesis. Sonography revealed acalculous cholecystitis, necessitating laparoscopic cholecystectomy that led to resolution of her condition. As hyperemesis is a diagnosis always arrived at by ruling out other possibilities, a complete physical examination should be performed and other patient symptoms must be considered in pregnant women with this disorder.

Purpose: Early diagnosis and prompt treatment of acute acalculous cholecystitis is important, because it is associated with high mortality. In major trauma patients, besides the direct damage the trauma itself causes, many complications can occur due to trauma. The purpose of this study was to evaluate the prevalence and risk factors for development of acute acalculous cholecystitis in patients with severe traumatic injuries. Methods: In this retrospective study, we reviewed the trauma registry data of 629 major trauma patients (injury severity score>15) of Eulji University Hospital seen between May 2012 and March 2015. Of the 629 patients, twelve were diagnosed with acute acalculous cholecystitis. Information collected from the medical record review included demographic data, clinical characteristics, laboratory findings, and diagnostic and therapeutic outcomes. Results: Twelve patients of 629 patients (1.9%) were diagnosed with acute acalculous cholecystitis, and while nine patients survived, three patients died. The clinical and laboratory findings at the initial emergency room visit and at diagnosis of acute acalculous cholecystitis were compared, and there were significant differences in the body temperature (p=0.002), C-reactive protein (CRP) (p=0.002), alkaline phosphatase (ALP) (p=0.008), total bilirubin (p=0.015), and lactate (p=0.046). Conclusion: Early diagnosis and proper treatment is important in acute acalculous cholecystitis after major trauma. If the patients after major trauma have elevated body temperature, lactate, CRP, ALP, and total bilirubin, one should keep in mind of the possibility of acute acalculous cholecystitis.

Acalculous cholecystitis, is a rare disease with a high morbidity and mortality, which is developed due to various reasons, including trauma and burn. Its diagnosis is based on clinical suspicion and physical examination. Ultrasonography and computed tomography scan can help in this regard. This report presents a case of post-traumatic acalculous cholecystitis in a 75-year-old patient expressing its method of diagnosis, treatment and outcome.

Acute inflammation of the gallbladder can occur without gallstones. Acalculous cholecystitis typically develops in critically ill patients in the intensive care unit.Patients on parenteral nutrition, with extensive burns, sepsis,major operations,multiple organ trauma or prolonged illness with multiple organ system failure are at risk for developing acalculous cholecystitis.The association of acalculous cholecystitis with Mirizzi syndrome is very unusual.Mirrizzi syndrome,which is an unusual cause of obstructive jaundice, is most commonly caused by a stone impacted in Hartmann’s pouch, exerting pressure over the common bile duct (CBD) with subsequent erosion into the CBD. The case we are presenting is a case of Mirrizi syndrome type-1 due to acalculous cholecystitis in a 13- year-old girl that presented with intermittent jaundice and RUQ abdominal pain and fever.Intraoperative finding showed Mirizzi syndrome type- 1 without gallstones.The cause of jaundice was only pressure of the gallbladder on the CBD and cholecystectomy with intraoperative cholangiography was performed.At post operative follow-up,the patient became anicteric and all symptoms and signs disappeared.

A 55-year old man was treated with sunitinib 50 mg/day for 4 weeks on and 2 weeks off, as a first-line therapy for metastatic renal cell carcinoma. During the fourth week of the first cycle, he was admitted to the Emergency Department with abdominal pain and vomiting. Acute acalculous cholecystitis was diagnosed. Sunitnib-associated cholecystitis is a rare adverse event previously reported in few cases. The mechanism behind this complication is not fully understood, although vascular endothelial dysfunction may play a role. The use of this drug is expanding in clinical oncology, and physicians should be aware of this life-threating adverse event.

Nontyphoidal salmonella are a rare case of acute acalculous cholecystitis. Salmonella Paratyphi B, which accounts for one of the less invasive NTS serotypes, has rarely been reported to cause cholecystitis. We describe a case of 65-year old previously healthy man, who present with signs of acute abdomen, due to biliary peritonitis as a complication of acute acalculous cholecystitis caused by Salmonella paratyphi B. Our case illustrates the potential severity of infection with Salmonella Paratyphi B especially in older patient. High index of awareness should be considered in endemic areas.

BACKGROUND: Emphysematous cholecystitis is life-threatening condition characterized by gas-forming infection of the gallbladder. It is mostly seems in old male patients with systemic, specially diabetes and vascular diseases. CASE REPORT: - A 30-year-old man without previous diseases was admitted because of right upper quadrant pain and nausea. On admission the patient was febrile (38.7o) with normal bilirubin levels. The white blood count was 26700/µl and reactive protein C was 470. Axial sections of single slice computed tomography imaging (section thickness 5 mm), revealed gallbladder wall enhancement after i.v. contrast, as well as dilatation of the gallbladder with intraluminal air. The patient underwent open cholecystectomy. The culture of the bile showed clostridium perfringes. The postoperative course of the patient was uneventful. CONCLUSION: This is a rare form of cholecystitis that carries a high mortality and usually present insidious clinical signs. CT is the most accurate imaging technique. Antibiotic therapy should begin quickly and include coverage of common pathogens, particularly Clostridia. Surgical intervention should take place as early as possible.INTRODUÇÃO: Colecistite enfisematosa é uma condição de risco de vida caracterizada por infecção da vesícula biliar por agentes produtores de gás. Na sua apresentação mais comum atinge preferencialmente homens idosos portadores de doenças sistêmicas em especial diabetes e vasculopatias. RELATO DO CASO: Paciente do sexo masculino, 30 anos de idade e sem co-morbidades que se apresenta ao pronto-socorro com história de dor abdominal em hipocôndrio direito há cinco dias, febre (38,7o) e náuseas. Os exames laboratoriais mostravam leucocitose (26700/µl) e elevação dos marcadores de inflamação (proteína C reativa, PCR 470). A tomografia computadorizada do abdome revelou realce da parede vesicular após injeção de contraste i.v., bem como dilatação da vesícula com a presença de ar intraluminal. O paciente foi submetido à colecistectomia através de incisão subcostal direita. A cultura da bile foi positiva para Clostridium perfringes. A evolução pós-operatória do paciente foi satisfatória. CONCLUSÃO: Esta é uma rara forma de colecistite com alta mortalidade e usualmente se apresenta com sinais clínicos insidiosos.Tomografia computadorizada é a mais acurada forma de diagnóstico de imagem. Antibioticoterapia de largo espectro deve começar rapidamente incluindo proteção à Clostridia. Procedimento cirúrgico deve ser indicado tão cedo quanto possível.