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

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

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1
Department of Digestive Diseases, Yale University School of Medicine, New Haven, CT.
2
Department of Interventional Radiology, Yale University School of Medicine, New Haven, CT.
3
Department of Surgery, Yale University School of Medicine, New Haven, CT.
4
Yale New Haven Transplantation Center, Transplantation and Immunology, New Haven, CT.

Abstract

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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