Acute emphysematous cholecystitis with initial normal radiological evaluation: a fatal diagnostic pitfall in the ED

Acute emphysematous cholecystitis is a relatively rare disease, a severe variant of acute cholecystitis, that predominantly affects elderly diabetic men. The apparently high mortality and morbidity associated with acute emphysematous cholecystitis have previously emphasized the importance of prompt diagnosis and emergent surgical intervention. Radiological evaluation including plain plain abdominal radiograph (KUB), abdominal sonography, and computed tomography of abdomen is the cornerstone of diagnosis of acute emphysematous cholecystitis. We describe a nondiabetic woman who developed sepsis due to acute emphysematous cholecystitis with rapid deterioration within 24 hours. She was misdiagnosed as having peptic ulcer disease initially due to normal KUB, abdominal sonography, and computed tomography of abdomen.