Q.. What
is the diagnosis in this diabetic woman?
(a) Toxic
megacolon
(b)
Emphysematous cholecystitis
(c) Ileus
(d)
Diverticular disease
(e)
Volvulus
Ans:B.
The diagnosis here is emphysematous
cholecystitis because air can be seen in the wall of the gallbladder. The
condition, due to infection, most commonly occurs in elderly female diabetics
and is usually caused by coliforms.
Causes of gas in the biliary tree
Within the bile ducts
1.
Incompetence of the sphincter of Oddi following
sphincterotomy, passage of a
gallstone or in the elderly (‘patulous sphincter’)
2.
Postoperative cholecystectomy or choledochoenterostomy
3.
Spontaneous biliary fistula due to passage of
gallstone from gallbladder to bowel,
duodenal ulcer
perforating into common bile duct, tumour or malignancy
Within the gallbladder-
• Emphysematous cholecystitis
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