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ACG Case Rep J. 2013 Oct 8;1(1):51-4. doi: 10.14309/crj.2013.18. eCollection 2013 Oct.

Emphysematous Cholecystitis Resulting in Secondary Biliary Cirrhosis: A Rare Complication of Endoscopic Retrograde Cholangiopancreatography.

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Department of Digestive Diseases, Yale University School of Medicine, New Haven, CT.
Department of Interventional Radiology, Yale University School of Medicine, New Haven, CT.
Department of Surgery, Yale University School of Medicine, New Haven, CT.
Yale New Haven Transplantation Center, Transplantation and Immunology, New Haven, CT.


A 48-year-old female developed acute emphysematous cholecystitis after an endoscopic retrograde cholangiopancreatography (ERCP) for evaluation of sphincter of Oddi dysfunction. Cholecystectomy was performed 2 days later. Cultures grew Clostridium perfringens. The patient received broad-spectrum antibiotics but developed recurrent cholangitic abscesses and intra- and extra-hepatic biliary necrosis. She was managed by percutaneous transhepatic biliary drains. For next 3 years, patient had recurrent episodes of biliary obstruction, cholangitis, and sepsis, resulting in secondary biliary cirrhosis requiring a liver transplantation. Emphysematous cholecystitis is a rare complication of ERCP. Prompt diagnosis and surgical management can prevent further spread of infection to biliary tree.

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