From the Guidelines
Air in the gallbladder typically indicates a serious medical condition, such as emphysematous cholecystitis, which requires prompt medical attention to prevent complications like tissue necrosis and potential gallbladder rupture. This condition is often associated with an infection of the gallbladder with gas-forming bacteria, and its diagnosis is supported by findings from relevant imaging studies, such as ultrasound or CT scans, which can show air in the gallbladder, pericholecystic fluid, and a distended gallbladder 1. The clinical presentation of emphysematous cholecystitis often includes severe right upper quadrant pain, fever, nausea, and vomiting.
Causes and Diagnosis
The presence of air in the gallbladder can also be due to other causes, including abnormal connections (fistulas) between the gallbladder and intestines, recent endoscopic procedures involving the bile ducts, or previous gallbladder surgery. The diagnosis of air in the gallbladder is primarily made through imaging studies, with CT scans being the most sensitive for detecting small amounts of air 1. Ultrasound is also a valuable tool in the diagnosis of gallbladder diseases, including the detection of air, and is often used as the first-line imaging modality due to its availability and non-invasive nature.
Treatment and Management
The management of emphysematous cholecystitis involves immediate treatment with broad-spectrum antibiotics, such as piperacillin-tazobactam, meropenem, or a combination of ciprofloxacin and metronidazole, and usually surgical removal of the gallbladder (cholecystectomy) 1. Patients with this condition often require hospitalization for intravenous antibiotics, pain management, and fluid resuscitation before surgery. Early diagnosis and surgical intervention are crucial in decreasing morbidity and mortality rates associated with gallbladder perforation, a potential complication of emphysematous cholecystitis 1.
Key Considerations
It is essential to approach the management of air in the gallbladder with a sense of urgency, given the potential for serious complications. The choice between early and delayed cholecystectomy should be based on the patient's condition, the presence of complications, and the availability of surgical resources 1. In critically ill patients or those with multiple comorbidities, cholecystostomy may be considered as a temporary measure to manage the condition until the patient is stable enough for surgery 1.
From the Research
Air in the Gallbladder
- Air in the gallbladder, also known as pneumobilia, can be an indication of several conditions, including:
- Gallstone ileus: a rare complication of gallstones where a gallstone lodges in the intestine, causing an obstruction 2, 3, 4
- Cholecysto-duodenal fistula: a fistula that forms between the gallbladder and the duodenum, allowing air to enter the gallbladder 5, 2, 4
- Bouveret's syndrome: a rare variant of gallstone ileus where a large gallstone impacts in the proximal duodenum, causing gastric outlet obstruction and aerobilia 5
- The presence of air in the gallbladder can be detected through imaging techniques such as computed tomography (CT) scans, which can also help identify other signs of gallstone ileus, such as Rigler's Triad (small intestinal obstruction, pneumobilia, and an ectopic stone in the intestine) 2, 3, 4