A 50-year-old chronic diabetic presents with severe abdominal pain, nausea, vomiting and fever. Abdominal imaging shows the following. What is the next best step in managing this patient?
Emergency cholecystectomy
ERCP
Observation for few days and repeat imaging
Elective cholecystectomy
Emphysematous cholecystitis is a life-threatening form of acute cholecystitis More commonly seen in patients with immunosuppression (diabetics) or vascular disease. Radiologically it shows a distended gallbladder with gas in the in the gallbladder wall and lumen (air-fluid levels may be seen). Treatment requires emergency cholecystectomy and broad-spectrum parenteral antibiotic therapy.
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