From the Guidelines
Emphysematous cholecystitis is primarily associated with diabetes mellitus, which is the most significant risk factor, along with other factors such as older age, male gender, and previous abdominal surgery. The risk factors for emphysematous cholecystitis can be identified as follows:
- Diabetes mellitus: This is the most significant risk factor, as it impairs microcirculation and increases the risk of bacterial infection 1.
- Older age: Typically over 50 years, as it increases the risk of compromised blood supply to the gallbladder 1.
- Male gender: Associated with an increased risk of complications and conversion to open cholecystectomy, which may be related to increased skeletal muscle mass and visceral abdominal fat 1.
- Previous abdominal surgery: A risk factor for conversion to open cholecystectomy due to intra-abdominal adhesions related to previous abdominal surgery 1.
- Other factors: Such as peripheral vascular disease, immunocompromised states, gallstones, alcohol abuse, and conditions causing bile stasis or gallbladder ischemia, which can contribute to the development of emphysematous cholecystitis. The pathophysiology of emphysematous cholecystitis involves gas-forming bacteria infecting the gallbladder wall, leading to gas formation within the gallbladder lumen, wall, or surrounding tissues 1. This occurs due to compromised blood supply to the gallbladder in combination with bacterial infection, particularly in patients with impaired microcirculation from diabetes or vascular disease. Prompt recognition and treatment are essential, as emphysematous cholecystitis represents a severe, potentially life-threatening variant of acute cholecystitis with higher rates of gallbladder perforation and mortality compared to non-emphysematous cholecystitis 1.
From the Research
Risk Factors for Emphysematous Cholecystitis
The risk factors for emphysematous cholecystitis include:
- Systemic disease, especially diabetes and vascular disease 2, 3
- Arteriosclerosis and embolic events 3
- Ischemia of the gallbladder wall with secondary gas-producing bacterial proliferation 4
- Advanced age, with the condition being more common in elderly men 2
Associated Conditions
Emphysematous cholecystitis has been associated with:
- Gas-forming organisms, such as Clostridium perfringens 3, 4
- Acute cholecystitis, with emphysematous cholecystitis being a rare and severe form of the condition 5, 6
- Emphysematous pancreatitis, with simultaneous occurrence of both conditions being possible 6
Demographics
The condition has been reported in various age groups, including: