Emphysematous Cholecystitis — SCE Infectious Diseases MCQ

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HardHealthcare-Associated InfectionsEmphysematous CholecystitisSCE Infectious Diseases

A 55-year-old man with diabetes develops emphysematous cholecystitis. CT shows gas within the gallbladder wall and pericholecystic fluid. He is septic. What organisms are most commonly implicated?

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Correct answer: C — Clostridium perfringens and E. coli — gas-forming organisms in the context of gallbladder ischaemia (diabetes predisposes to microvascular disease)

Emphysematous cholecystitis is a severe variant of acute cholecystitis with gas in the gallbladder wall, caused by gas-forming organisms (Clostridium perfringens ~45%, E. coli, Klebsiella, anaerobes). It is strongly associated with diabetes (50% of cases) due to microvascular ischaemia of the gallbladder wall promoting anaerobic bacterial proliferation. Management is urgent cholecystectomy plus broad-spectrum IV antibiotics (Piperacillin/Tazobactam or Meropenem plus Metronidazole). Mortality is 15–25% — significantly higher than simple cholecystitis.

Reference: NICE NG104 2014 – Gallstone disease; WSES 2020 – Acute cholecystitis