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文献考察：気腫性胆嚢炎（Emphysematous cholecystitis）
Radiographics. 2002 May-Jun;22(3):543-61.
Emphysematous infections of the abdomen and pelvis: a pictorial review.
Grayson DE, Abbott RM, Levy AD, Sherman PM.
Emphysematous (gas-forming) infections of the abdomen and pelvis represent potentially life-threatening conditions that require aggressive medical and often surgical management. The initial clinical manifestation of these entities may be insidious, but rapid progression to sepsis will occur in the absence of early therapeutic intervention. Conventional radiography and ultrasonography are often the initial imaging modalities used to evaluate patients with abdominopelvic complaints. However, when a differential diagnosis remains, or if further localization or confirmation of tentative findings is needed, computed tomography (CT) should be considered the imaging modality of choice. CT is both highly sensitive and specific in the detection of abnormal gas and well suited to reliable depiction of the anatomic location and extent of the gas. Of equal importance may be the capability of CT to help reliably identify benign sources of gas, because treatment (if any) varies dramatically depending on the source. Knowledge of the pathophysiologic characteristics, common predisposing conditions, and typical imaging features associated with gas-forming infections of the gallbladder, stomach, pancreas, and genitourinary system will help make early diagnosis and successful treatment possible. In addition, such knowledge will aid in further diagnostic work-up, surveillance of potential complications, and evaluation of therapeutic response.（full text） PMID: 12006686
追記：気腫性胆嚢炎は，胆石と胆嚢炎が女性に多いこととは反対に50〜70歳代の，基礎疾患として糖尿病と動脈硬化症を有する男性に多く（男：女 2:1），胆嚢動脈の血流障害が重要な役割を果たしていると考えられる．無石性の頻度が高く，壊死・穿孔例が多い．原因菌はClostridium welchiiとEscherichia coli.が多い．病態の進行度は，Stage I：胆嚢腔内だけのガス，Stage II：壁内ガスも認める，Stage III：胆嚢外にもガスを認める，に分類される．遊離ガスは胆嚢穿孔を意味し，緊急手術の適応である．通常の急性胆嚢炎の死亡率が4％であるのに対して，気腫性胆嚢炎の死亡率は15％と高い．
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