Emphysematous cholecystitis. Advantages of abdominal ultrasound in the ED

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), wellcircumscribed, 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.