eP217 Pneumoperitoneum, perfringens and pneumatosis of the gallbladder: a reflective case report

Aims This reflective case report describes a rare presentation of emphysematous cholecystitis (EC) complicated by pneumoperitoneum without free bile. We aim to highlight the diagnostic challenges, management strategies, and outcomes associated with this life-threatening condition to improve clinical understanding and patient care. Methods A 64-year-old male with high BMI, type 2 diabetes mellitus, hypertension, hypercholesterolaemia and learning disability presented with a six-day history of abdominal pain and bloating. Initial blood tests revealed marked leukocytosis with neutrophilia, and an elevated C-reactive protein. Abdominal examinations were unremarkable. A computed tomography scan demonstrated gas within the gallbladder and free air within the peritoneal cavity, without evidence of free fluid or bile. The patient underwent emergency laparoscopic cholecystectomy, with samples sent for microbiological analysis. Postoperatively, the patient received tailored antibiotic therapy. Results Intraoperative findings included an inflamed, necrotic gallbladder with gas between the posterior wall and muscle layer. Free pus was present around the gallbladder but no macroperforation or fistula was identified. Cultures from the gallbladder fluid grew Enterococcus faecalis and Clostridium perfringens. The patient had an uncomplicated postoperative recovery and was discharged following a thirteen-day hospital admission. At four-week follow-up, he remained well. Conclusions This case highlights the atypical findings in a case of emphysematous cholecystitis with pneumoperitoneum in the absence of free bile or evident perforation. Early surgical interventional and appropriate antibiotic therapy are critical for successful outcomes. Further studies are needed to better understand the pathophysiology and optimal management of this rare condition.