The correct answer is:

It carries a high risk of gallbladder perforation.

Educational Objective:

Define the clinical significance of emphysematous cholecystitis.

Key Point:

Emphysematous cholecystitis occurs predominantly in patients with diabetes, often in the absence of gallstones. Emphysematous cholecystitis is associated with a high risk of gallbladder gangrene and perforation and usually requires urgent cholecystectomy.

Explanation:

Emphysematous cholecystitis is an uncommon, but highly morbid, form of acute cholecystitis that occurs most commonly in men with diabetes.

It presumably occurs when ischemia permits gas-forming bacteria to invade the gallbladder wall.

Although gallstones may be present in emphysematous cholecystitis, 50% of cases are acalculous, suggesting a pathophysiologic mechanism that is primarily ischemic, rather than mechanically obstructive.

The clinical presentation is similar to that of acute cholecystitis; however, in patients with diabetes who have neuropathy, the Murphy sign may be absent, which may be misleading.

The hallmark imaging finding in emphysematous cholecystitis is air within the gallbladder wall.

As the diagnosis carries a high risk for gallbladder gangrene and perforation, treatment is typically broad-spectrum antibiotics and urgent cholecystectomy (usually open).

References:

Haines L, Oyama LC. Disorders of the liver and biliary tract. In: Walls R, et al. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed., 2018:1083-1103.