The authors experienced a typical case of acute emphysematous cholecystitis following Billroth 11 type gastric resection due to stomach cancer. Many investigators, especially European and British, have given interests for a definite increase in chronic cholecystitis with or without stones, in postgastrectomy patients.
Usually cholecystitis is predominant in women in pregastrectomy group but men are much greater predominant in postgastrectomy group.
The most popular theories for cholecystitis following gastric surgery involve the adverse effect of vagotomy or the inadeequate liberation of cholecystokinin by diversion of the acid chyme from the duodenum.
When there is a recurrence of digestive complainst after gastry, the biliary tract should be examined before assuming failure of gastric surgery, as a cause of postgastrectomy digestive disturbance.
Emphysematous cholecystitis, an unusual inflammatory condition of the gallbladder, is associated with acute cholecystitis and is characterized by gas, due to gas forming bacteria, in the gallbladder lumen and wall. About 150 cases have been reported in the world literatures till now.
The prime contributing factor is a permanent or temporary obstruction of the cystic duct, usually due to stones. There may be other causes of duct obstruction, such as anomalous vessels, adhesions, tumors, lymphnodes, kinks or vascular occllusion.
Emphysematous cholecystitis is more common in men than women and is not infrequently associated with diabetes mellitus.
Bile culture made at operation are positive in slightly more than 50 per cent of the patients, and the organisms most commonly recovered are clostredia and coliform. Approximately half of the patients have calculi in the gallbladder.
|