Presentation
Referred for treatment of hypoglycemia. Painful in cranial abdomen on abdominal palpation.
Patient Data
There is free peritoneal gas noted between the liver and the diaphragm, as well as multiple fragmented gas lucencies throughout the peritoneal space and superimposed over the liver. The gall bladder is enlarged with gas lucencies within the wall and within the lumen. There is irregular granular material noted within the lumen as well. There is decrease in abdominal serosal detail particularly in the cranial abdomen. There are small mineral fragments ventral to the thoracolumbar spine and on the left side, which may be within the stomach. The small bowel loops are fluid- and gas-filled, and some are at the upper limits of normal for size. There are numerous sites of spondylosis deformans along the lumbar spine including the lumbosacral junction.
Emphysematous cholecystitis with rupture, pneumoperitoneum, and effusion.
Case Discussion
Emphysematous cholecystitis with pneumoperitoneum. The primary differential is gall bladder rupture with concurrent peritonitis. Exploratory laparotomy is recommended if clinically indicated. The patient was euthanized without necropsy.
Free gas in the abdomen may collect under the diaphragm or as bubbles within the peritoneal effusion.
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